Provider Demographics
NPI:1427417740
Name:SCRANTON, LISA CAROL (RD, LD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:SCRANTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 HIGH COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1110
Mailing Address - Country:US
Mailing Address - Phone:319-594-5681
Mailing Address - Fax:
Practice Address - Street 1:610 EASTBURY DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-7603
Practice Address - Country:US
Practice Address - Phone:319-358-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01515133V00000X
IL164.006312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered