Individual
MRS. LISA MARGARET HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
64 MIRUELA AVE, ST AUGUSTINE, FL 32080-3864
(904) 392-1030
Mailing address
64 MIRUELA AVE, ST AUGUSTINE, FL 32080
(904) 392-1030
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
924093
IL
Other
Enumeration date
05/26/2006
Last updated
08/09/2017
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