Provider Demographics
NPI:1073919668
Name:OLIVER, LISA (NUTRITION THERAPIST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NUTRITION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 GROVESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8391
Mailing Address - Country:US
Mailing Address - Phone:888-238-4078
Mailing Address - Fax:
Practice Address - Street 1:1417 GREGG ST
Practice Address - Street 2:SUITE1
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3527
Practice Address - Country:US
Practice Address - Phone:888-238-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist