Provider Demographics
NPI:1982912515
Name:PAYNE, ELIZABETH DOVER (RD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DOVER
Last Name:PAYNE
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 1:2225 LAKESIDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6750
Mailing Address - Country:US
Mailing Address - Phone:434-238-0900
Mailing Address - Fax:434-316-6115
Practice Address - Street 1:2225 LAKESIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6750
Practice Address - Country:US
Practice Address - Phone:434-238-0900
Practice Address - Fax:434-316-6115
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA915200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered