Provider Demographics
NPI:1649935487
Name:LOWE, ELISE ANN (MS, RD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:LOWE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:ANN
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7950 ETIWANDA AVE APT 8208
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8711
Mailing Address - Country:US
Mailing Address - Phone:909-658-5130
Mailing Address - Fax:
Practice Address - Street 1:7950 ETIWANDA AVE APT 8208
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8711
Practice Address - Country:US
Practice Address - Phone:909-658-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86007453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered