Provider Demographics
NPI:1124619796
Name:CRANE, ELIZABETH B (MSRDN LB)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:CRANE
Suffix:
Gender:F
Credentials:MSRDN LB
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BRONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-783-6500
Mailing Address - Fax:
Practice Address - Street 1:222 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86020520OtherKY MEDICAL LICENSE