Provider Demographics
NPI:1740344159
Name:LOOSEMORE, ELIZABETH DIANE (PHD, RD, LDN)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIANE
Last Name:LOOSEMORE
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOOPERS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-7588
Mailing Address - Country:US
Mailing Address - Phone:828-676-6627
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR STE 102
Practice Address - Street 2:MISSION WEIGHT MANAGEMENT CENTER
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2425
Practice Address - Country:US
Practice Address - Phone:828-213-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered