Provider Demographics
NPI:1336903640
Name:BOHNENSTIEHL, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BOHNENSTIEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19618 S QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-9306
Mailing Address - Country:US
Mailing Address - Phone:660-620-2755
Mailing Address - Fax:
Practice Address - Street 1:19618 S QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-9306
Practice Address - Country:US
Practice Address - Phone:660-620-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered