Provider Demographics
NPI:1790267656
Name:MATHEWS, LISA EILEEN (MS, RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:EILEEN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1816
Mailing Address - Country:US
Mailing Address - Phone:615-969-8316
Mailing Address - Fax:
Practice Address - Street 1:4321 CAROTHERS PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8542
Practice Address - Country:US
Practice Address - Phone:615-435-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2630133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered