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General NPI Number Information
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NPI Number | 1558459685
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Entity Type | Individual
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Provider Name | LISA LYNN RANDALL RDN, LD, CDE
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 105 W 8TH AVE STE 7010
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City | SPOKANE
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State | WA
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Zip | 99204-2312
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Country | US
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Telephone | 509-474-6525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4114
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City | PASADENA
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State | CA
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Zip | 91110-0001
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Country | US
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Telephone | 866-747-2455
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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 | DI00001131
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License Number State | WA
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