Provider Demographics
NPI:1619637170
Name:ZUCCARELLI, LORELEI (RDN)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:
Last Name:ZUCCARELLI
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 1:2908 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-4340
Mailing Address - Country:US
Mailing Address - Phone:219-718-9270
Mailing Address - Fax:
Practice Address - Street 1:2908 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-4340
Practice Address - Country:US
Practice Address - Phone:219-718-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered