Provider Demographics
NPI:1093267379
Name:EAGER, LISA M (RDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EAGER
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 1:318 S WEBBER DR
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1420
Mailing Address - Country:US
Mailing Address - Phone:315-510-3297
Mailing Address - Fax:
Practice Address - Street 1:318 S WEBBER DR
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1420
Practice Address - Country:US
Practice Address - Phone:315-510-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86041688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered