Provider Demographics
NPI:1093753014
Name:CIMPERMAN, LISA MARIE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:CIMPERMAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 SKYLINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3909 ORANGE PL
Practice Address - Street 2:
Practice Address - City:ORANGE VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44122-4478
Practice Address - Country:US
Practice Address - Phone:216-831-8311
Practice Address - Fax:216-595-5357
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5393133N00000X
OH933117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCIMT72701Medicare ID - Type Unspecified