Provider Demographics
NPI:1275179681
Name:HUANG, LORI NICHOLE (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:NICHOLE
Last Name:HUANG
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3128
Mailing Address - Country:US
Mailing Address - Phone:864-275-8846
Mailing Address - Fax:
Practice Address - Street 1:203 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4019
Practice Address - Country:US
Practice Address - Phone:864-271-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC898244133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal