Provider Demographics
NPI:1487074753
Name:SMITH, ELIZABETH FAE (MS, RD, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 IDLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-1200
Mailing Address - Country:US
Mailing Address - Phone:614-638-6986
Mailing Address - Fax:
Practice Address - Street 1:436 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-5532
Practice Address - Country:US
Practice Address - Phone:412-347-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered