Provider Demographics
NPI:1104450238
Name:ELAN FITNESS AND NUTRITION
Entity type:Organization
Organization Name:ELAN FITNESS AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATSWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:202-600-9826
Mailing Address - Street 1:1751 PINNACLE DRIVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:202-600-9826
Mailing Address - Fax:
Practice Address - Street 1:1751 PINNACLE DR STE 600
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4007
Practice Address - Country:US
Practice Address - Phone:202-600-9826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Single Specialty