Healthcare Provider Details

I. General information

NPI: 1295917219
Provider Name (Legal Business Name): LISA ANN MESSERLI MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E 3RD AVE STE 1
DURANGO CO
81301-5049
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2288
  • Fax:
Mailing address:
  • Phone: 970-335-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number930699
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: