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General NPI Number Information
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NPI Number | 1942836556
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Entity Type | Individual
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Provider Name | ELIZABETH WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/15/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 937 S 3RD ST APT A
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City | COLUMBUS
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State | OH
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Zip | 43206-2542
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Country | US
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Telephone | 614-304-1857
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Fax |
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Provider Business Mailing Address
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Address Line | 937 S 3RD ST APT A
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City | COLUMBUS
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State | OH
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Zip | 43206-2542
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Country | US
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Telephone | 419-206-9531
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1067574
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License Number State | OH
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