Basic Information
| Provider Information | |||||||||
| NPI: | 1306131669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | RD,LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777300 | ||||||||
| FaxNumber: | 8437777311 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 E CHEVES ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437775701 | ||||||||
| FaxNumber: | 8437777320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 06/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 358 | SC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.