Provider Demographics
NPI:1558035063
Name:MARSHALL, LORI E (BS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MIDDLE STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:646-298-0263
Mailing Address - Fax:
Practice Address - Street 1:110 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5674
Practice Address - Country:US
Practice Address - Phone:508-894-0766
Practice Address - Fax:508-565-0097
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered