Healthcare Provider Details

I. General information

NPI: 1740807437
Provider Name (Legal Business Name): LISA SCHRADER MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 08/09/2023
Certification Date: 09/14/2021
Deactivation Date: 09/14/2021
Reactivation Date: 08/09/2023

III. Provider practice location address

733 CHICAGO AVE UNIT 505
EVANSTON IL
60202-2381
US

IV. Provider business mailing address

733 CHICAGO AVE UNIT 505
EVANSTON IL
60202-2381
US

V. Phone/Fax

Practice location:
  • Phone: 630-779-0120
  • Fax:
Mailing address:
  • Phone: 630-779-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.007414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: