Provider Demographics
NPI:1285999649
Name:WYMAN, ELIZABETH M (RD,CDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:WYMAN
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5724
Mailing Address - Country:US
Mailing Address - Phone:518-836-5977
Mailing Address - Fax:518-348-4156
Practice Address - Street 1:1270 DEAN ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-5724
Practice Address - Country:US
Practice Address - Phone:518-836-5977
Practice Address - Fax:518-348-4156
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007507163WD0400X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator