Provider Demographics
NPI:1780062976
Name:OVERGAAUW, ELIZABETH (RD, LD, LMNT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OVERGAAUW
Suffix:
Gender:F
Credentials:RD, LD, LMNT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 SERGEANT RD
Mailing Address - Street 2:STORE #1614
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4705
Mailing Address - Country:US
Mailing Address - Phone:712-274-1036
Mailing Address - Fax:
Practice Address - Street 1:4500 SERGEANT RD
Practice Address - Street 2:STORE #1614
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4705
Practice Address - Country:US
Practice Address - Phone:712-274-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077925133V00000X
NE102152133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered