Provider Demographics
NPI:1366803314
Name:WOLK, LISA (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WOLK
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 SUGARLOAF HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-1502
Mailing Address - Country:US
Mailing Address - Phone:570-233-3459
Mailing Address - Fax:
Practice Address - Street 1:237 SUGARLOAF HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-1502
Practice Address - Country:US
Practice Address - Phone:570-233-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered