Healthcare Provider Details

I. General information

NPI: 1952442618
Provider Name (Legal Business Name): LISA D SMALLEN-LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807
US

IV. Provider business mailing address

6604 ANDOAH RD
KNOXVILLE TN
37918-4601
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3867
  • Fax: 865-992-7238
Mailing address:
  • Phone: 865-208-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: