Provider Demographics
NPI:1902089907
Name:SINGER, LISA (CN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SINGER
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44319 SILVER CANYON LN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3078
Mailing Address - Country:US
Mailing Address - Phone:760-238-8895
Mailing Address - Fax:
Practice Address - Street 1:44319 SILVER CANYON LN
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3078
Practice Address - Country:US
Practice Address - Phone:760-238-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000889133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO000889OtherAHSU/NINE