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General NPI Number Information
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NPI Number | 1255943189
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Entity Type | Individual
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Provider Name | LISA MARSHALL RD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 07/06/2024
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Provider Practice Location Address
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Address Line | 17915 50TH ST E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-6715
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Country | US
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Telephone | 775-247-4123
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Fax |
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Provider Business Mailing Address
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Address Line | 5214 SW VIEW POINT TER
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City | PORTLAND
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State | OR
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Zip | 97239-3940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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