Provider Demographics
NPI:1891935334
Name:MCLEAN, LOLITA AGNES (RD , LD)
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:AGNES
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:RD , LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4787
Mailing Address - Country:US
Mailing Address - Phone:334-293-7133
Mailing Address - Fax:334-293-7374
Practice Address - Street 1:602 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4787
Practice Address - Country:US
Practice Address - Phone:334-293-7133
Practice Address - Fax:334-293-7374
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL722133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist