Provider Demographics
NPI:1023090677
Name:RAFFANTI, LUCIE M (LDN)
Entity type:Individual
Prefix:
First Name:LUCIE
Middle Name:M
Last Name:RAFFANTI
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 24TH AVE N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1520
Mailing Address - Country:US
Mailing Address - Phone:615-321-9556
Mailing Address - Fax:615-321-9544
Practice Address - Street 1:345 24TH AVE N
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1520
Practice Address - Country:US
Practice Address - Phone:615-321-9556
Practice Address - Fax:615-321-9544
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001283133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3241600Medicare ID - Type Unspecified