| Doctor Name: | LISA ANN WYLIE |
| NPI Number: | 1003073842 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | |
| Business Practice Address: | 300 E Warwick Dr Alma, MI - 488011014 |
| Business Phone Number: | 9894663330 |
| Business Fax Number: | 9894632540 |
| Mailing Address: | Po Box 188, ALMA |
| State: | MI |
| Postal Code: | 488010188 |
| Phone Number: | 9894663349 |
| Fax Number: | 9894667454 |
| NPI Enumeration Date: | 05/20/2008 |
| NPI Last Update Date: | 05/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1005X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Renal |
| Taxonomy Definition: | |