Healthcare Provider Details

I. General information

NPI: 1760955868
Provider Name (Legal Business Name): ELIZABETH ANNE CONRAD RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FAYETTEVILLE ST STE 300
RALEIGH NC
27601-1469
US

IV. Provider business mailing address

2201 SW 18TH ST
BENTONVILLE AR
72713-7022
US

V. Phone/Fax

Practice location:
  • Phone: 828-202-7841
  • Fax: 855-771-8942
Mailing address:
  • Phone: 757-630-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1844
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: