Provider Demographics
NPI:1912424110
Name:DROST, LISA MARIE (ND)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DROST
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3557
Mailing Address - Country:US
Mailing Address - Phone:630-920-3485
Mailing Address - Fax:
Practice Address - Street 1:315 W FOREST AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3557
Practice Address - Country:US
Practice Address - Phone:630-920-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006932133N00000X
VT099.0000153175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist