Provider Demographics
NPI:1609598978
Name:LOVETT, MALLORYE DELORIS (RDN)
Entity Type:Individual
Prefix:
First Name:MALLORYE
Middle Name:DELORIS
Last Name:LOVETT
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 1:3401 CARL SANDBURG CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2049
Mailing Address - Country:US
Mailing Address - Phone:919-212-8580
Mailing Address - Fax:
Practice Address - Street 1:3401 CARL SANDBURG CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2049
Practice Address - Country:US
Practice Address - Phone:919-212-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC926078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty