Individual
MRS. LISA A EDEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2200 H ST, FAIRBURY, NE 68352-1119
(402) 729-6846
Mailing address
2200 H ST, PO BOX 277, FAIRBURY, NE 68352-1119
(402) 729-6846
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
641
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025484200
—
NE
Enumeration date
08/25/2008
Last updated
12/28/2009
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