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General NPI Number Information
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NPI Number | 1417456955
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Entity Type | Individual
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Provider Name | LISA CARROLL MS, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 02/11/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 525 S WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-6749
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Country | US
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Telephone | 630-926-5472
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 N GREENVIEW AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60642-2352
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Country | US
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Telephone | 630-926-5472
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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 | 164.005331
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License Number State | IL
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