Provider Demographics
NPI:1386719607
Name:GLOEDE, LISE ANNE (RD)
Entity type:Individual
Prefix:MS
First Name:LISE
Middle Name:ANNE
Last Name:GLOEDE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 LEE HWY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1619
Mailing Address - Country:US
Mailing Address - Phone:703-575-1007
Mailing Address - Fax:703-358-8703
Practice Address - Street 1:5275 LEE HWY
Practice Address - Street 2:SUITE #101
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-575-1007
Practice Address - Fax:703-358-8703
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1489551OtherCIGNA HEALTHCARE PROVIDER
VA7480122OtherAETNA PROVIDER NUMBER
VA2294420OtherUNITED HEALTHCARE PROVIDE
VA1489551OtherCIGNA HEALTHCARE PROVIDER