Provider Demographics
NPI:1780914457
Name:ZAHRADNICEK, LISA RENEE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENEE
Last Name:ZAHRADNICEK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 FALCON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8225
Mailing Address - Country:US
Mailing Address - Phone:502-265-0049
Mailing Address - Fax:
Practice Address - Street 1:709 FALCON RIDGE LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8225
Practice Address - Country:US
Practice Address - Phone:502-265-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-01
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered