Provider Demographics
NPI:1003455684
Name:KARUZIE, LISA MARIE (MS RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:KARUZIE
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:RINALDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:177 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1755
Mailing Address - Country:US
Mailing Address - Phone:570-241-5784
Mailing Address - Fax:
Practice Address - Street 1:1111 EAST END BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003516133V00000X
PA961556133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered