Provider Demographics
NPI:1952442618
Name:SMALLEN-LEE, LISA D
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:SMALLEN-LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 ANDOAH RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4601
Mailing Address - Country:US
Mailing Address - Phone:865-208-5588
Mailing Address - Fax:
Practice Address - Street 1:4335 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807
Practice Address - Country:US
Practice Address - Phone:865-992-3867
Practice Address - Fax:865-992-7238
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education