Individual
LISA JEWETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
1501 TROUSDALE DR, 3RD FLOOR, BURLINGAME, CA 94010-4506
(650) 652-8500
(650) 652-8556
Mailing address
577 AIRPORT BLVD STE 300, BURLINGAME, CA 94010-2048
(650) 240-8198
(408) 328-5695
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
PHN41722
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09325739
NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATOR
CA
Enumeration date
01/20/2016
Last updated
03/18/2016
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