Provider Demographics
NPI:1649040601
Name:MARRS, ELISE (RDN)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MARRS
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 1:1661 E CAMELBACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3913
Mailing Address - Country:US
Mailing Address - Phone:623-231-3686
Mailing Address - Fax:480-351-8384
Practice Address - Street 1:1500 N WILMOT RD UNIT C-280
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4416
Practice Address - Country:US
Practice Address - Phone:520-836-5725
Practice Address - Fax:480-351-8384
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86115747133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered