Provider Demographics
NPI:1447589080
Name:FLANDERS, LISA SUZANNE (MS, RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUZANNE
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14847 STRAWTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-6974
Mailing Address - Country:US
Mailing Address - Phone:765-534-3381
Mailing Address - Fax:765-534-3381
Practice Address - Street 1:14847 STRAWTOWN AVE
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-6974
Practice Address - Country:US
Practice Address - Phone:765-534-3381
Practice Address - Fax:765-534-3381
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001090A133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric