NPI 1104464734 · live from the CMS NPI Registry
Lisa Lauritzen Smith, RDN
Dietitian, Registered in Jackson, WY. National Provider Identifier 1104464734, active.
NPI record
| NPI | 1104464734 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 625 E Broadway Ave, Jackson, WY 83001 |
| Practice phone | 307-739-7357 |
| Mailing address | Po Box 428, Jackson, WY 83001 |
| Enumerated | December 13, 2019 |
| Last updated | February 18, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 071 (WY) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.