Provider Demographics
NPI:1538639513
Name:PIAZZA, LISA A (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S MICHIGAN AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2810
Mailing Address - Country:US
Mailing Address - Phone:312-454-2700
Mailing Address - Fax:
Practice Address - Street 1:1411 S MICHIGAN AVE FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2810
Practice Address - Country:US
Practice Address - Phone:312-454-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007498133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered