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Individual

LISA GREENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
96 BRIDGEWOOD DR, MANSFIELD, TX 76063-5539
(972) 896-5858
Mailing address
96 BRIDGEWOOD DR, MANSFIELD, TX 76063-5539
(972) 896-5858

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT05641
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05641
TEXAS LICENSED DIETITIAN
TX
Enumeration date
10/26/2006
Last updated
06/15/2024
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