Provider Demographics
NPI:1740486778
Name:BECKER, LISA MARIE (RD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 94TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:ND
Mailing Address - Zip Code:58464-9268
Mailing Address - Country:US
Mailing Address - Phone:701-262-4925
Mailing Address - Fax:
Practice Address - Street 1:104 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4103
Practice Address - Country:US
Practice Address - Phone:701-587-6000
Practice Address - Fax:701-587-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered