Active NPI
Lisa Wilson Martin, RD, MS, LDN
- Registered Dietitian
- Raleigh, NC
National Provider Identifier
1952517955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L002570
- Practice address
- 11200 Galleria Avenue
Raleigh, NC 27614 - Phone
- (919) 570-1511
- Fax
- (919) 570-7751
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | L002570 | NC | |
| Registered Dietitian | 133V00000X | L002570 | NC | Primary |
Addresses
Primary practice location
11200 Galleria Avenue
Raleigh, NC 27614
Mailing address
211 Friday Center Dr
Suite 2091, Room 2094 Hedrick Building
Chapel Hill, NC 27517-9499
Phone (984) 974-1191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L002570 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1952517955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 FRIDAY CENTER DR",
"address_2": "SUITE 2091, ROOM 2094 HEDRICK BUILDING",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275179499",
"telephone_number": "984-974-1191",
"fax_number": "984-974-1311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11200 GALLERIA AVENUE",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27614",
"telephone_number": "919-570-1511",
"fax_number": "919-570-7751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "LISA",
"middle_name": "WILSON",
"name_prefix": "Mrs.",
"credential": "RD, MS, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "NC",
"license": "L002570",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L002570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.