Healthcare Provider Details

I. General information

NPI: 1841518040
Provider Name (Legal Business Name): LISA LOUDEN WITHEROW MS, FDN-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4997 CAMBRIA WAY
WESTERVILLE OH
43081
US

IV. Provider business mailing address

4997 CAMBRIA WAY
WESTERVILLE OH
43081-6633
US

V. Phone/Fax

Practice location:
  • Phone: 614-378-2092
  • Fax:
Mailing address:
  • Phone: 614-378-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: