Provider Demographics
NPI:1861821704
Name:REID, LISA MURRAY (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MURRAY
Last Name:REID
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 1:1901 TERESA FIELDS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-6422
Mailing Address - Country:US
Mailing Address - Phone:719-213-8246
Mailing Address - Fax:
Practice Address - Street 1:1901 TERESA FIELDS LN
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-6422
Practice Address - Country:US
Practice Address - Phone:719-213-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education