Provider Demographics
NPI:1366035560
Name:CARY, LISA ANN (RDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CARY
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 1:811 SEASONS PASS DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4753
Mailing Address - Country:US
Mailing Address - Phone:216-645-0510
Mailing Address - Fax:
Practice Address - Street 1:811 SEASONS PASS DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4753
Practice Address - Country:US
Practice Address - Phone:216-645-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered