Provider Demographics
NPI:1306128657
Name:THOMPSON, ELIZABETH CLAIRE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF THE ARMY HEADQUARTERS
Mailing Address - Street 2:QUALITY MANAGEMENT DIVISION (CREDENTIALS), UNIT #15281
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF THE ARMY HEADQUARTERS
Practice Address - Street 2:QUALITY MANAGEMENT DIVISION (CREDENTIALS), UNIT #15281
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5281
Practice Address - Country:US
Practice Address - Phone:315-737-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82614133V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program