Provider Demographics
NPI:1720721897
Name:GROVE, ELIZABETH (RD, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4143
Mailing Address - Country:US
Mailing Address - Phone:301-653-0324
Mailing Address - Fax:
Practice Address - Street 1:223 S FRONT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4143
Practice Address - Country:US
Practice Address - Phone:301-653-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08966133V00000X
86050924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered