Provider Demographics
NPI:1871860908
Name:HARTMAN, LISA A (RD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:HARTMAN
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 1:1 MEDFORD LEAS
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2254
Mailing Address - Country:US
Mailing Address - Phone:609-654-3399
Mailing Address - Fax:609-654-5519
Practice Address - Street 1:1 MEDFORD LEAS
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2254
Practice Address - Country:US
Practice Address - Phone:609-654-3399
Practice Address - Fax:609-654-5519
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ817172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered