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General NPI Number Information
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NPI Number | 1275600397
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Entity Type | Individual
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Provider Name | LISA MARIE MERRILL M.S.,R.D.
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 3939 VAN HORN RD
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City | TRENTON
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State | MI
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Zip | 48183-4013
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Country | US
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Telephone | 734-502-8264
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Fax | 877-287-7216
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Provider Business Mailing Address
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Address Line | 3341 22ND ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-6012
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Country | US
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Telephone | 734-502-8264
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Fax | 734-362-7501
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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 | 804989
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License Number State | MI
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