Provider Demographics
NPI:1417993619
Name:OLIVER, LISA M
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:OLIVER WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:565 DURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-7983
Mailing Address - Country:US
Mailing Address - Phone:919-329-0425
Mailing Address - Fax:
Practice Address - Street 1:VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:508 FULTON ST
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-286-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered