Provider Demographics
NPI:1518400761
Name:HUDSON, LISA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 RICHMOND AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2429
Mailing Address - Country:US
Mailing Address - Phone:832-451-2763
Mailing Address - Fax:
Practice Address - Street 1:12000 RICHMOND AVE STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2429
Practice Address - Country:US
Practice Address - Phone:832-451-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered