Provider Demographics
NPI:1538487095
Name:PAVKA, ELIZABETH ANN (PHD, RD, LD/N)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:PAVKA
Suffix:
Gender:F
Credentials:PHD, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2328
Mailing Address - Country:US
Mailing Address - Phone:828-252-1406
Mailing Address - Fax:828-255-5858
Practice Address - Street 1:25 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2328
Practice Address - Country:US
Practice Address - Phone:828-252-1406
Practice Address - Fax:828-255-5858
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered