Provider Demographics
NPI:1922373463
Name:HARRIS, LISA ANN (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E PROSPECT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5304
Mailing Address - Country:US
Mailing Address - Phone:970-224-3636
Mailing Address - Fax:970-224-3637
Practice Address - Street 1:1106 E PROSPECT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5304
Practice Address - Country:US
Practice Address - Phone:970-224-3636
Practice Address - Fax:970-224-3637
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO802178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered