MEDICARE: LISA MURRAY REID RD

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	133NN1002X	Nutrition Education Nutritionist
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1861821704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MURRAY REID RD

Provider Business Mailing Address
First Line	:	1901 TERESA FIELDS LN
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-6422
Country	:	US
Telephone Number	:	719-213-8246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 TERESA FIELDS LN
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-6422
Country	:	US
Telephone Number	:	719-213-8246
Fax Number	:

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

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	11/01/2013

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