Individual
LISA SPROUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD
Contact information
Practice address
4423 SADDLE SPUR, SAN ANTONIO, TX 78253-4487
(210) 215-5653
Mailing address
4423 SADDLE SPUR, SAN ANTONIO, TX 78253-4487
(210) 215-5653
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT06434
TX
133VN1005X
Renal Nutrition Registered Dietitian
DT06434
TX
Other
Enumeration date
07/13/2023
Last updated
12/04/2023
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