Provider Demographics
NPI:1053713644
Name:AKERSON, LISA (RD LD CDE)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:AKERSON
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 OAKLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3848
Mailing Address - Country:US
Mailing Address - Phone:505-321-3560
Mailing Address - Fax:
Practice Address - Street 1:8800 OAKLAND AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3848
Practice Address - Country:US
Practice Address - Phone:505-321-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM808290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered