Healthcare Provider Details

I. General information

NPI: 1093753014
Provider Name (Legal Business Name): LISA MARIE CIMPERMAN R.D., L.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ORANGE PL
ORANGE VILLAGE OH
44122-4478
US

IV. Provider business mailing address

7781 SKYLINEVIEW DR
MENTOR OH
44060-7431
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-8311
  • Fax: 216-595-5357
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number5393
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number933117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: