Provider Demographics
NPI:1114117066
Name:SCHWINN, LISA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SCHWINN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HACKNEY LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8285
Mailing Address - Country:US
Mailing Address - Phone:815-585-2318
Mailing Address - Fax:
Practice Address - Street 1:403 HACKNEY LN
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8285
Practice Address - Country:US
Practice Address - Phone:815-585-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004028133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered