Provider Demographics
NPI:1841518040
Name:WITHEROW, LISA LOUDEN (MS, FDN-P)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LOUDEN
Last Name:WITHEROW
Suffix:
Gender:F
Credentials:MS, FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4997 CAMBRIA WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6633
Mailing Address - Country:US
Mailing Address - Phone:614-378-2092
Mailing Address - Fax:
Practice Address - Street 1:4997 CAMBRIA WAY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-378-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other