Provider Demographics
NPI:1760620512
Name:BERNS, LISA DAWN (RD, CD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:BERNS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 396
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9345
Mailing Address - Country:US
Mailing Address - Phone:812-847-9293
Mailing Address - Fax:
Practice Address - Street 1:13402 W 160 N
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-6572
Practice Address - Country:US
Practice Address - Phone:812-847-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN807772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered