Provider Demographics
NPI:1225624059
Name:WALSER, ELIZABETH BEESON (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BEESON
Last Name:WALSER
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:PO BOX 604050
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4050
Mailing Address - Country:US
Mailing Address - Phone:336-740-9060
Mailing Address - Fax:336-740-9659
Practice Address - Street 1:6371 JESSIE LN
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9887
Practice Address - Country:US
Practice Address - Phone:336-740-9060
Practice Address - Fax:336-740-9659
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered