Provider Demographics
NPI:1831664994
Name:DEERING, LORI J (RD, CD, CEDRD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:DEERING
Suffix:
Gender:F
Credentials:RD, CD, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 N ASSOCIATION DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1479
Mailing Address - Country:US
Mailing Address - Phone:920-364-9078
Mailing Address - Fax:920-243-1792
Practice Address - Street 1:3416 N ASSOCIATION DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1479
Practice Address - Country:US
Practice Address - Phone:920-364-9078
Practice Address - Fax:920-243-1792
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI795-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered