Healthcare Provider Details

I. General information

NPI: 1205302700
Provider Name (Legal Business Name): ELIZABETH FIELD GUILLEMETTE NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N STATE OF FRANKLIN RD STE 400B
JOHNSON CITY TN
37604-6089
US

IV. Provider business mailing address

408 N STATE OF FRANKLIN RD STE 31B
JOHNSON CITY TN
37604-6088
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-4946
  • Fax: 423-431-4947
Mailing address:
  • Phone: 423-431-4946
  • Fax: 423-431-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: