Provider Demographics
NPI:1134901176
Name:WHITAKER, ELIZA (RDN)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HATTIE CLARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-3116
Mailing Address - Country:US
Mailing Address - Phone:607-373-5244
Mailing Address - Fax:
Practice Address - Street 1:322 HATTIE CLARK RD
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-3116
Practice Address - Country:US
Practice Address - Phone:607-373-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered