Provider Demographics
NPI:1770625030
Name:NOGUEIRA, LISA MARIE (RD LD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:NOGUEIRA
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MOUNT DELIGHT RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03037-1304
Mailing Address - Country:US
Mailing Address - Phone:603-463-8067
Mailing Address - Fax:
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered