Provider Demographics
NPI:1053726984
Name:SMITH, LISA (RDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 COUNTY ROAD 309A
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-9131
Mailing Address - Country:US
Mailing Address - Phone:970-759-1241
Mailing Address - Fax:970-564-2274
Practice Address - Street 1:2130 COUNTY ROAD 309A
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137-9131
Practice Address - Country:US
Practice Address - Phone:970-759-1241
Practice Address - Fax:970-564-2274
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered