Provider Demographics
NPI:1609829977
Name:AUBRY, LISA L (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:AUBRY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7265
Mailing Address - Fax:520-872-7963
Practice Address - Street 1:6566 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-885-3588
Practice Address - Fax:520-290-3958
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ917126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ917126OtherCDR