Provider Demographics
NPI:1538401559
Name:BEAUDIS, LISA MARIE (RD,LD,CDE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BEAUDIS
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JEFFERSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3354
Mailing Address - Country:US
Mailing Address - Phone:724-983-7324
Mailing Address - Fax:724-983-5515
Practice Address - Street 1:32 JEFFERSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3354
Practice Address - Country:US
Practice Address - Phone:724-983-7324
Practice Address - Fax:724-983-5515
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5364133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered