Provider Demographics
NPI:1750488540
Name:LANZANO, LISA (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LANZANO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18990
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1990
Mailing Address - Country:US
Mailing Address - Phone:720-414-5102
Mailing Address - Fax:
Practice Address - Street 1:4410 ARAPAHOE AVE STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1135
Practice Address - Country:US
Practice Address - Phone:720-414-5102
Practice Address - Fax:720-306-4644
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00838488133V00000X
CO838488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered