Provider Demographics
NPI:1730961558
Name:MAGURA, ELIZABETH ANN MARIE (RD, IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN MARIE
Last Name:MAGURA
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 W 600 N
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-9498
Mailing Address - Country:US
Mailing Address - Phone:219-781-3152
Mailing Address - Fax:
Practice Address - Street 1:773 W 600 N
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-9498
Practice Address - Country:US
Practice Address - Phone:219-781-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-309682174N00000X
IN86019306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN