Provider Demographics
NPI:1679995880
Name:KOLE, LORRAINE (RDN)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:KOLE
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 1:19812 REDWING ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2617
Mailing Address - Country:US
Mailing Address - Phone:818-888-2206
Mailing Address - Fax:
Practice Address - Street 1:19812 REDWING ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2617
Practice Address - Country:US
Practice Address - Phone:818-888-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist