Healthcare Provider Details

I. General information

NPI: 1104493881
Provider Name (Legal Business Name): LISA NJOROGE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 RAWHIDE LN
LAWRENCE KS
66046-5162
US

IV. Provider business mailing address

2730 RAWHIDE LN
LAWRENCE KS
66046-5162
US

V. Phone/Fax

Practice location:
  • Phone: 785-760-1831
  • Fax:
Mailing address:
  • Phone: 785-760-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2327
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: