Provider Demographics
NPI:1699225938
Name:PERRY, LISA (RDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PERRY
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 1:5848 PERRYTOWN DR
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1508
Mailing Address - Country:US
Mailing Address - Phone:248-961-0561
Mailing Address - Fax:
Practice Address - Street 1:6400 FARMINGTON RD STE 114
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2208
Practice Address - Country:US
Practice Address - Phone:248-961-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered