Healthcare Provider Details

I. General information

NPI: 1346712494
Provider Name (Legal Business Name): LISA WILLIAMS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W LANCASTER AVE STE 253
DEVON PA
19333-1592
US

IV. Provider business mailing address

857 COLONY RD
BRYN MAWR PA
19010-1103
US

V. Phone/Fax

Practice location:
  • Phone: 610-615-1055
  • Fax: 610-598-6017
Mailing address:
  • Phone: 516-241-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0011481
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008500
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN008500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: