Provider Demographics
NPI:1205131273
Name:MOYLAN, ELIZABETH (RD, CDE, MPH)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:RD, CDE, MPH
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MOYLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVE BLDG 51NICOE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:BUILDING 51- NICOE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-594-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered