Provider Demographics
NPI:1649494196
Name:BUCKLEY, LISA M (RD, LDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DEITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 145 NE ONCOLOGY ASSOCIATES
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-783-1370
Mailing Address - Fax:704-783-1389
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 145 NE ONCOLOGY ASSOCIATES
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-783-1370
Practice Address - Fax:704-783-1389
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC925612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered