Provider Demographics
NPI:1982356697
Name:TAYLOR, ELISE (RD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N FRANKLIN ST APT 214
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2987
Mailing Address - Country:US
Mailing Address - Phone:415-763-2159
Mailing Address - Fax:
Practice Address - Street 1:222 N FRANKLIN ST APT 214
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2987
Practice Address - Country:US
Practice Address - Phone:415-763-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86019834133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered