Provider Demographics
NPI:1881108561
Name:MCCUNE, LISA (RD, LDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCCUNE
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 830242
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1141
Practice Address - Country:US
Practice Address - Phone:855-699-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI249-LD133V00000X
NMLD1425133V00000X
UT11741417-4901133V00000X
MT87758133V00000X
NE1496133V00000X
WY312133V00000X
DCDI00001123133V00000X
TN2153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered