Individual
LISA VANATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, CSP
Contact information
Practice address
1919 E THOMAS RD BLDG 3, PHOENIX, AZ 85016-7710
(602) 933-0970
(602) 933-4253
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
718221
AZ
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327149
—
AZ
Enumeration date
02/01/2019
Last updated
07/16/2019
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