Provider Demographics
NPI:1538580717
Name:RIDER, LISA P (MA, RD, LDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:RIDER
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BRADFORD TER
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1818
Mailing Address - Country:US
Mailing Address - Phone:610-918-9388
Mailing Address - Fax:
Practice Address - Street 1:725 BRADFORD TER
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-1818
Practice Address - Country:US
Practice Address - Phone:610-918-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002247133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic