Basic Information
| Provider Information | |||||||||
| NPI: | 1427525617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANAKWENZE | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | MPH, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W LIBERTY ST STE 1910 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107218313 | ||||||||
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| Practice Location | |||||||||
| Address1: | 530 S JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025623000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2018 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 172V00000X | N | Other Service Providers | Community Health Worker | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 1744R1102X | N | Other Service Providers | Specialist | Research Study | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.