Provider Demographics
NPI:1326646852
Name:MATHEWS, LORI (RD,LD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NE 10TH ST UNIT 157
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-1402
Mailing Address - Country:US
Mailing Address - Phone:405-204-5157
Mailing Address - Fax:
Practice Address - Street 1:1611 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-4610
Practice Address - Country:US
Practice Address - Phone:405-204-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered