Provider Demographics
NPI:1194710095
Name:SWANNER, ELIZABETH (RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:SWANNER
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 JEFFERSON DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2017
Mailing Address - Country:US
Mailing Address - Phone:318-388-4354
Mailing Address - Fax:
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-327-4072
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
133VN1004XMedicare ID - Type UnspecifiedPEDIATRIC NUTRITION
LA133VN1005XMedicare ID - Type UnspecifiedRENAL NUTRITION
LA133V00000Medicare ID - Type UnspecifiedREGISTERED DIETITIAN
LA133NN1002XMedicare ID - Type UnspecifiedNUTRITION,EDUCATION
LA133N0000XMedicare ID - Type UnspecifiedNUTRITIONIST