Individual
LISA MIKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
80 UNIVERSITY PL, NEW YORK, NY 10003-4564
(832) 766-4420
Mailing address
330 E 39TH ST APT 35M, NEW YORK, NY 10016-2137
(832) 766-4420
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86003765
TX
Other
Enumeration date
06/08/2014
Last updated
06/08/2014
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