Provider Demographics
NPI:1851766810
Name:HARKINS, LISA (RD/LDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARKINS
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAND PIPER DR
Mailing Address - Street 2:UNIT 13
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-2779
Mailing Address - Country:US
Mailing Address - Phone:302-388-2856
Mailing Address - Fax:302-260-9221
Practice Address - Street 1:17527 NASSAU COMMONS BLVD
Practice Address - Street 2:STE 111
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6283
Practice Address - Country:US
Practice Address - Phone:302-388-2856
Practice Address - Fax:302-260-9221
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered