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General NPI Number Information
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NPI Number | 1750916581
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Entity Type | Individual
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Provider Name | LISA JO FINSTROM
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Gender | Female
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | VILLAGE GREEN APOTHECARY 5415 W. CEDAR LANE
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City | BETHESDA
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State | MD
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Zip | 20814-2081
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Country | US
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Telephone | 301-646-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 6214 STONEHAM RD
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City | BETHESDA
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State | MD
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Zip | 20817-1759
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Country | US
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Telephone | 301-646-7560
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX4828
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License Number State | MD
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