Provider Demographics
NPI:1326552530
Name:O'CONNELL, LORNA J (MS, RDN, CD)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:J
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-8634
Mailing Address - Country:US
Mailing Address - Phone:317-500-1421
Mailing Address - Fax:
Practice Address - Street 1:2860 W SHORE DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-8634
Practice Address - Country:US
Practice Address - Phone:317-500-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN652608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered