Provider Demographics
NPI:1821637778
Name:SMITH, LISA ANN (MA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 10TH ST
Mailing Address - Street 2:
Mailing Address - City:APLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:50604-1073
Mailing Address - Country:US
Mailing Address - Phone:319-240-2209
Mailing Address - Fax:
Practice Address - Street 1:522 10TH ST
Practice Address - Street 2:
Practice Address - City:APLINGTON
Practice Address - State:IA
Practice Address - Zip Code:50604-1073
Practice Address - Country:US
Practice Address - Phone:319-240-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered