Provider Demographics
NPI:1861646085
Name:TAYLOR, LISA VINCENT (RD,)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:VINCENT
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1304
Mailing Address - Country:US
Mailing Address - Phone:508-478-5883
Mailing Address - Fax:508-473-6251
Practice Address - Street 1:14 PROSPECT STREET
Practice Address - Street 2:MILFORD REGIONAL MEDICAL CENTER
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-422-2393
Practice Address - Fax:508-473-6251
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA956570133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered