Provider Demographics
NPI:1609549898
Name:BIXBY, LISA (RDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BIXBY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 MEDALLION DR E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9068
Mailing Address - Country:US
Mailing Address - Phone:248-880-8380
Mailing Address - Fax:
Practice Address - Street 1:5751 MEDALLION DR E
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9068
Practice Address - Country:US
Practice Address - Phone:248-880-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL865436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered