Provider Demographics
NPI:1467969881
Name:BOCKWEG, LOREN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:BOCKWEG
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 D ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5722
Mailing Address - Country:US
Mailing Address - Phone:202-251-2673
Mailing Address - Fax:
Practice Address - Street 1:5200 27TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1326
Practice Address - Country:US
Practice Address - Phone:202-251-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered