Provider Demographics
NPI:1609263441
Name:EELLS, ELIZABETH (RD LDN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:EELLS
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WIERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:600 NE WATER ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4246
Mailing Address - Country:US
Mailing Address - Phone:309-282-1613
Mailing Address - Fax:
Practice Address - Street 1:600 NE WATER ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4246
Practice Address - Country:US
Practice Address - Phone:309-282-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered