Individual
MRS. LISA ANNE WYCKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CSR, LD
Contact information
Practice address
7415 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7834
(352) 795-1415
(352) 564-0147
Mailing address
9 SHUMARD CT S, HOMOSASSA, FL 34446-4720
(352) 382-2048
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
ND2626
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00025278
MEDICARE RAILROAD
FL
Enumeration date
01/24/2007
Last updated
07/08/2007
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