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General NPI Number Information
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NPI Number | 1881636918
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Entity Type | Individual
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Provider Name | ELIZABETH CHRISTINE KOUSTIS MS, RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 8787 BROOKPARK RD
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City | CLEVELAND
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State | OH
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Zip | 44129-6809
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Country | US
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Telephone | 216-739-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 5503
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License Number State | OH
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