Provider Demographics
NPI:1902480783
Name:NGUYEN, LISA VU (MSC, RDN, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:VU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MSC, RDN, LDN, CNSC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:VU
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSC, RDN, LDN, CNSC
Mailing Address - Street 1:3742 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6627
Mailing Address - Country:US
Mailing Address - Phone:404-663-6863
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-663-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered