Provider Demographics
NPI:1396472791
Name:BEILMAN, LISA NICOLE (RD, LDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:BEILMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S OLIVE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3723
Mailing Address - Country:US
Mailing Address - Phone:570-647-9138
Mailing Address - Fax:
Practice Address - Street 1:190 W GERMANTOWN PIKE STE 155
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1383
Practice Address - Country:US
Practice Address - Phone:610-229-9060
Practice Address - Fax:610-229-9060
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86115822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN007315OtherSTATE BOARD OF NURSING
PA86115822OtherCOMMISSION ON DIETETIC REGISTRATION