Individual
LISA WILHELM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN, CNSC
Contact information
Practice address
1800 ORLEANS ST, BLOOMBERG 9306, BALTIMORE, MD 21287-0010
(410) 614-4486
Mailing address
1800 ORLEANS ST, BLOOMBERG 9306, BALTIMORE, MD 21287-0010
(410) 614-4486
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
164004668
IL
133V00000X
Registered Dietitian
Primary
DX3435
MD
Other
Enumeration date
11/20/2008
Last updated
09/15/2014
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