Provider Demographics
NPI:1548506546
Name:CARDA, LISA M (RD, CD,)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CARDA
Suffix:
Gender:F
Credentials:RD, CD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-2402
Mailing Address - Country:US
Mailing Address - Phone:920-623-1244
Mailing Address - Fax:920-623-1250
Practice Address - Street 1:1515 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-2402
Practice Address - Country:US
Practice Address - Phone:920-623-1244
Practice Address - Fax:920-623-3546
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI936-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered