Provider Demographics
NPI:1427423458
Name:TABARY REMSEN, ELISE CHRISTINE (RD,LDN)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:CHRISTINE
Last Name:TABARY REMSEN
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:TABARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2300 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3619
Practice Address - Country:US
Practice Address - Phone:815-971-2550
Practice Address - Fax:815-971-9550
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2402133V00000X
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered