Provider Demographics
NPI:1316108129
Name:MYERS, ELIZABETH ANN (MBA, RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:MBA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT. A4
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4552
Mailing Address - Country:US
Mailing Address - Phone:716-908-3488
Mailing Address - Fax:
Practice Address - Street 1:1590 SOUTHWESTERN BLVD
Practice Address - Street 2:APT. A4
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4552
Practice Address - Country:US
Practice Address - Phone:716-908-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered