Healthcare Provider Details

I. General information

NPI: 1639689730
Provider Name (Legal Business Name): ELIZABETH MARIE-VENNEFRON CALVELAGE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 VINE ST
CINCINNATI OH
45202-1141
US

IV. Provider business mailing address

PO BOX 830242
PHILADELPHIA PA
19182-0242
US

V. Phone/Fax

Practice location:
  • Phone: 855-699-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37003143A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1928
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1276
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1732
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT92291
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI200001551
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006002
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.08340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: