Provider Demographics
NPI:1962144964
Name:MARSO, ELIZABETH (RDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARSO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-5705
Mailing Address - Country:US
Mailing Address - Phone:605-280-9676
Mailing Address - Fax:
Practice Address - Street 1:740 E SIOUX AVE STE 116
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3396
Practice Address - Country:US
Practice Address - Phone:605-280-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered