Provider Demographics
NPI:1295139327
Name:BASHAM, ELIZABETH DANOWSKY (MS, RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANOWSKY
Last Name:BASHAM
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2486 AKEPA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1070
Mailing Address - Country:US
Mailing Address - Phone:808-849-4788
Mailing Address - Fax:
Practice Address - Street 1:3806 CANEY CREEK RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2246
Practice Address - Country:US
Practice Address - Phone:808-859-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.010140133V00000X
IA953628133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered