Basic Information
| Provider Information | |||||||||
| NPI: | 1548464571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRIS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | GRIFFIN | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1781 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936312022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598974852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CLOVIS COMMUNITY MEDICAL CENTER | ||||||||
| Address2: | 2755 HERNDON AVENUE | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593244000 | ||||||||
| FaxNumber: | 5593243732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 916376 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.