Provider Demographics
NPI:1679778849
Name:WATANABE, ELIZABETH ANN (RD, LD, CDM)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WATANABE
Suffix:
Gender:F
Credentials:RD, LD, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TONGASS DR
Mailing Address - Street 2:MEDICAL NUTRITION SERVICES
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9416
Mailing Address - Country:US
Mailing Address - Phone:907-966-8339
Mailing Address - Fax:907-966-8395
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:MEDICAL NUTRITION SERVICES
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-8339
Practice Address - Fax:907-966-8395
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8ED850Medicare PIN