Provider Demographics
NPI:1700170099
Name:ELIA, DANA MARIE (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:ELIA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:THORNLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:15 BOX ELDER LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9605
Mailing Address - Country:US
Mailing Address - Phone:717-917-5259
Mailing Address - Fax:
Practice Address - Street 1:15 BOX ELDER LN
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9605
Practice Address - Country:US
Practice Address - Phone:717-917-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN001779OtherPA STATE LICENSE NUMBER
00859033OtherCOMMISSION ON DIETETIC REGISTRATION