MEDICARE: LISA J LORD NBC-HWC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1538100912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J LORD NBC-HWC

Provider Business Mailing Address
First Line	:	2592 VINING BRANCH WAY
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-8520
Country	:	US
Telephone Number	:	919-998-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2592 VINING BRANCH WAY
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-8520
Country	:	US
Telephone Number	:	919-998-9143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/16/2022

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