Provider Demographics
NPI:1871636993
Name:LOHRY, BONNIE J (DIETICIAN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:LOHRY
Suffix:
Gender:F
Credentials:DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3725
Mailing Address - Country:US
Mailing Address - Phone:712-294-5000
Mailing Address - Fax:712-294-5091
Practice Address - Street 1:2501 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3725
Practice Address - Country:US
Practice Address - Phone:712-294-5000
Practice Address - Fax:712-294-5091
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA305 00600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7205Medicare ID - Type Unspecified
P67707Medicare UPIN