Provider Demographics
NPI:1689879058
Name:WILBY, LISA (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WILBY
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 1:200 WORCESTER CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3934
Mailing Address - Country:US
Mailing Address - Phone:413-218-5275
Mailing Address - Fax:
Practice Address - Street 1:200 WORCESTER CT
Practice Address - Street 2:UNIT A
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3934
Practice Address - Country:US
Practice Address - Phone:413-218-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered