Provider Demographics
NPI:1265086359
Name:WALKER, ELIZABETH (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1301
Mailing Address - Country:US
Mailing Address - Phone:607-742-5717
Mailing Address - Fax:
Practice Address - Street 1:30 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1301
Practice Address - Country:US
Practice Address - Phone:607-742-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered