Individual
ELIZABETH M KLISMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., C.D.
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Mailing address
2630 FAIRFIELD PL, MADISON, WI 53704-4825
(608) 520-2575
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2902-29
DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
01
—
86063520
COMMISSION ON DIETETIC REGISTATION
—
Enumeration date
04/11/2016
Last updated
04/12/2016
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