Provider Demographics
NPI:1013351873
Name:STAAS-HOUSER, LISA A (MS, RD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STAAS-HOUSER
Suffix:
Gender:F
Credentials:MS, 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 EVES DR
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3125
Mailing Address - Country:US
Mailing Address - Phone:856-626-0040
Mailing Address - Fax:
Practice Address - Street 1:1 EVES DR
Practice Address - Street 2:SUITE 126
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3125
Practice Address - Country:US
Practice Address - Phone:856-626-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ707626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered