Provider Demographics
NPI:1144098104
Name:THUDE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4412
Mailing Address - Country:US
Mailing Address - Phone:610-639-1879
Mailing Address - Fax:
Practice Address - Street 1:28 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4412
Practice Address - Country:US
Practice Address - Phone:610-639-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-313988163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant