Individual
JEANNINE LILOETT LISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CD
Contact information
Practice address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Mailing address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2260-029
STATE LICENSURE
WI
Enumeration date
05/18/2010
Last updated
05/18/2010
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