Individual
LISHA ANDREW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2894
(401) 793-4719
(401) 793-7072
Mailing address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2894
(401) 793-4719
(401) 793-7072
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
4627-NU-NU
MA
133V00000X
Registered Dietitian
Primary
LDN00982
RI
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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