Lisa Ann Fenn, MS RD LD
Individual provider Active NPI Registered Dietitian · Juneau, AK
NPI 1124154851 · NPPES record last updated Jun 26, 2009
Key facts
- NPI
- 1124154851
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 108 (AK)
- Practice address
- 3245 Hospital Dr
Searhc
Juneau, AK 99801-7809 - Phone
- (907) 463-4040
- Fax
- (907) 463-4673
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108 | AK | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 108 | AK | Yes |
Addresses
Primary practice location
3245 Hospital Dr
Searhc
Juneau, AK 99801-7809
Mailing address
222 Tongass Drive
Searhc
Sitka, AK 99835
Phone (907) 966-2411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DT2342 | Medicaid | AK |
Other names
- Lisa Ann Nicklow
Other providers in Juneau, AK
- John Faust
- Timothy Floyd Fay
- Michele Federico
- Erin E. Felke-Caf
- Colleen Felkl
- David Alan Ferguson
- Naja Ferrer
- Katherine Ann Ferris
- Flora File
- Alvin J Fineman
All providers in Juneau, AK · Registered Dietitian in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.