Provider Demographics
NPI:1366585374
Name:ZMOLEK, ELIZABETH FAYE (RD, LD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAYE
Last Name:ZMOLEK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 EAST ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537
Mailing Address - Country:US
Mailing Address - Phone:641-208-6712
Mailing Address - Fax:
Practice Address - Street 1:6580 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-8793
Practice Address - Country:US
Practice Address - Phone:641-932-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12085Medicare ID - Type UnspecifiedMEDICARE PART B