Provider Demographics
NPI:1356079768
Name:HEIMS, LISA M (RDN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:HEIMS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DAYTONA AVE
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1625
Mailing Address - Country:US
Mailing Address - Phone:856-278-2278
Mailing Address - Fax:
Practice Address - Street 1:40 DAYTONA AVE
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1625
Practice Address - Country:US
Practice Address - Phone:856-278-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered