Healthcare Provider Details

I. General information

NPI: 1013786177
Provider Name (Legal Business Name): ELIZABETH GILBANE RD, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 WASHINGTON RD
WEST PALM BEACH FL
33405-1644
US

IV. Provider business mailing address

3109 WASHINGTON RD
WEST PALM BEACH FL
33405-1644
US

V. Phone/Fax

Practice location:
  • Phone: 908-433-5189
  • Fax:
Mailing address:
  • Phone: 908-433-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86276833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: