Provider Demographics
NPI:1548051394
Name:MARMOLEJO, LISA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MARMOLEJO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-2026
Mailing Address - Country:US
Mailing Address - Phone:701-779-5418
Mailing Address - Fax:
Practice Address - Street 1:20 MECHANICS ROW
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3302
Practice Address - Country:US
Practice Address - Phone:978-846-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered