Individual
LISA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DIETARY AIDE
Contact information
Practice address
522 MILL RD, CLARKSVILLE, AR 72830-8511
(479) 705-1301
Mailing address
PO BOX 1589, BENTON, AR 72018-1589
(501) 315-3344
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
—
—
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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