Provider Demographics
NPI:1487995486
Name:MIRE, LISA (RD, CSP, LDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MIRE
Suffix:
Gender:F
Credentials:RD, CSP, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Mailing Address - Street 2:3333 BURNET AVENUE, ML 5043
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4211
Mailing Address - Fax:513-636-5887
Practice Address - Street 1:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - Street 2:3333 BURNET AVENUE, ML 5043
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4211
Practice Address - Fax:513-636-5887
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002586133VN1004X
OHLD.08393133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric