Provider Demographics
NPI:1205011988
Name:JONES, LISA ANN (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:JONES
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 1:312 E BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2312
Mailing Address - Country:US
Mailing Address - Phone:267-474-9061
Mailing Address - Fax:
Practice Address - Street 1:312 E BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2312
Practice Address - Country:US
Practice Address - Phone:267-474-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered