Healthcare Provider Details

I. General information

NPI: 1194710095
Provider Name (Legal Business Name): ELIZABETH SWANNER RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-7407
US

IV. Provider business mailing address

3614 JEFFERSON DAVIS DR
MONROE LA
71201-2017
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-4072
  • Fax:
Mailing address:
  • Phone: 318-388-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1172
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: