Provider Demographics
NPI:1871080713
Name:DEMING, ELISE (RDN)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DEMING
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 1:134 OLDE FARM DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4966
Mailing Address - Country:US
Mailing Address - Phone:724-205-8333
Mailing Address - Fax:
Practice Address - Street 1:24 VETERANS SQ
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3155
Practice Address - Country:US
Practice Address - Phone:610-783-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered