Healthcare Provider Details

I. General information

NPI: 1174527634
Provider Name (Legal Business Name): ELIZABETH S TRINER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MARTHA CUSTIS DR UNIT 409
ALEXANDRIA VA
22302-2000
US

IV. Provider business mailing address

1225 MARTHA CUSTIS DR UNIT 409
ALEXANDRIA VA
22302-2000
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-9945
  • Fax:
Mailing address:
  • Phone: 703-717-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: