Healthcare Provider Details

I. General information

NPI: 1124619796
Provider Name (Legal Business Name): ELIZABETH B CRANE MSRDN LB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH BRONNER

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6500
  • Fax:
Mailing address:
  • Phone: 606-783-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: