Provider Demographics
NPI:1033431663
Name:WERNER, LISA MARIE I (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:WERNER
Suffix:I
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N C ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2812
Mailing Address - Country:US
Mailing Address - Phone:253-279-6771
Mailing Address - Fax:253-383-3615
Practice Address - Street 1:2104 N 30TH ST STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3341
Practice Address - Country:US
Practice Address - Phone:253-279-6771
Practice Address - Fax:253-383-3615
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered