MEDICARE: MS. LISA DREHER M.S., R.D.N., L.D.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1720350507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DREHER M.S., R.D.N., L.D.N.

Provider Business Mailing Address
First Line	:	38 CHURCH ST APT 2F
Second Line	:
City	:	LENOX
State	:	MA
Zip	:	01240-2502
Country	:	US
Telephone Number	:	845-519-5962
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE ULTRAWELLNESS CENTER
Second Line	:	55 PITTSFIELD RD #9
City	:	LENOX
State	:	MA
Zip	:	01240-0124
Country	:	US
Telephone Number	:	413-637-9991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	12/03/2018

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