Provider Demographics
NPI:1629830393
Name:LISA WOODRUFF NUTRITION, LLC
Entity Type:Organization
Organization Name:LISA WOODRUFF NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:515-290-4541
Mailing Address - Street 1:3355 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:712-248-8621
Practice Address - Street 1:3355 PENNY LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-9048
Practice Address - Country:US
Practice Address - Phone:515-290-4541
Practice Address - Fax:712-248-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center