Provider Demographics
NPI:1427446681
Name:OWCZARZAK, ELIZABETH KATE (MPH, RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATE
Last Name:OWCZARZAK
Suffix:
Gender:F
Credentials:MPH, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3711
Mailing Address - Country:US
Mailing Address - Phone:503-544-1994
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2023
Practice Address - Country:US
Practice Address - Phone:503-544-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1050748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered