Provider Demographics
NPI:1922419670
Name:STEWARD, LISA LOPEZ (MS, RD, CNSC, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LOPEZ
Last Name:STEWARD
Suffix:
Gender:F
Credentials:MS, RD, CNSC, LD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4315 DIPLOMACY DR
Mailing Address - Street 2:ANC-MNT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-2678
Mailing Address - Fax:907-729-2661
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:ANC-MNT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2678
Practice Address - Fax:907-729-2661
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered