Individual
MRS. LIZA JO LOCKLEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CD CDE
Contact information
Practice address
2641 DEVELOPMENT DR, GREEN BAY, WI 54311-4240
(920) 338-6868
(920) 338-6869
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1610-29
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21900466
NATIONAL CERTIFICATION BOARD FOR DIABETES
—
01
—
886243
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
11/02/2007
Last updated
02/10/2021
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