Healthcare Provider Details

I. General information

NPI: 1336481944
Provider Name (Legal Business Name): ELIZABETH LEES MS, RDN, CGN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 E INDIANOLA AVE
PHOENIX AZ
85016-5906
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 480-238-9769
  • Fax:
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1062302
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: