Provider Demographics
NPI:1336120674
Name:ROBINSON, LISA FARMONIA (MS)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:FARMONIA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S JENNINGS AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1112
Mailing Address - Country:US
Mailing Address - Phone:817-335-4325
Mailing Address - Fax:
Practice Address - Street 1:101 S JENNINGS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1112
Practice Address - Country:US
Practice Address - Phone:817-335-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42652Medicare UPIN
611722Medicare ID - Type Unspecified