Provider Demographics
NPI:1023781713
Name:LODE, VERONICA (RDN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:LODE
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 1:11601 HIDDEN VALLEY CV
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1319
Mailing Address - Country:US
Mailing Address - Phone:708-205-4035
Mailing Address - Fax:
Practice Address - Street 1:11601 HIDDEN VALLEY CV
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1319
Practice Address - Country:US
Practice Address - Phone:708-205-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004074133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty