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General NPI Number Information
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NPI Number | 1861358921
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Entity Type | Individual
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Provider Name | LISA MARIE WAKEFIELD RDN
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Gender | Female
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Dates
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Enumeration Date | 01/01/2026
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 7 GEMINI DR
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City | KEENE
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State | NH
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Zip | 03431-4831
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Country | US
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Telephone | 908-303-3109
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GEMINI DR
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City | KEENE
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State | NH
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Zip | 03431-4831
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Country | US
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Telephone | 908-303-3109
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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 | 074.0134253
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 4920
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1029
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License Number State | NH
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