Provider Demographics
NPI:1811493125
Name:NEWTON, ELIZABETH KELLIS (RD, CSOWM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELLIS
Last Name:NEWTON
Suffix:
Gender:F
Credentials:RD, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FOX HORN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-8246
Mailing Address - Country:US
Mailing Address - Phone:804-931-9177
Mailing Address - Fax:
Practice Address - Street 1:2955 IVY RD STE 1500
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9353
Practice Address - Country:US
Practice Address - Phone:434-243-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered