Provider Demographics
NPI:1548673064
Name:BOECKELMAN, ELIZABETH (RD, LDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOECKELMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S AIKEN AVE
Mailing Address - Street 2:EAST WING, ROOM EG-02
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1505
Mailing Address - Country:US
Mailing Address - Phone:412-623-2421
Mailing Address - Fax:412-623-2279
Practice Address - Street 1:510 S AIKEN AVE
Practice Address - Street 2:EAST WING, ROOM EG-02
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1505
Practice Address - Country:US
Practice Address - Phone:412-623-2421
Practice Address - Fax:412-623-2279
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered