Provider Demographics
NPI:1558608745
Name:NELSON, LISA MARY ANNA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARY ANNA
Last Name:NELSON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1730
Mailing Address - Country:US
Mailing Address - Phone:509-690-7192
Mailing Address - Fax:
Practice Address - Street 1:1855 AMES BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3429
Practice Address - Country:US
Practice Address - Phone:504-349-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00992520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered