Provider Demographics
NPI:1578181269
Name:LONEY, LEE ANN (RDN)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:LONEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6309
Mailing Address - Country:US
Mailing Address - Phone:575-921-1146
Mailing Address - Fax:
Practice Address - Street 1:1605 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6309
Practice Address - Country:US
Practice Address - Phone:575-921-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85136133V00000X
NMLN-0814133N00000X
NMLD-0905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist