Basic Information
| Provider Information | |||||||||
| NPI: | 1639166390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RD LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2710 SAINT FRANCIS DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192725358 | ||||||||
| FaxNumber: | 3192725445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2710 SAINT FRANCIS DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192725358 | ||||||||
| FaxNumber: | 3192725445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2005 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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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 | 01585 | IA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.