Healthcare Provider Details

I. General information

NPI: 1982124673
Provider Name (Legal Business Name): ELIZABETH PIERCE ABRAMS RD, CSP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH PIERCE BUSTAMANTE RD, CSP

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 E PIMA ST
TUCSON AZ
85716-3308
US

IV. Provider business mailing address

6591 N POSITANO WAY
TUCSON AZ
85741-3038
US

V. Phone/Fax

Practice location:
  • Phone: 520-477-7752
  • Fax:
Mailing address:
  • Phone: 520-609-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-124887
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: