Provider Demographics
NPI:1336921352
Name:LOR, ANNA (RDN, LDN, MS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LOR
Suffix:
Gender:F
Credentials:RDN, LDN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2858
Mailing Address - Country:US
Mailing Address - Phone:910-479-5801
Mailing Address - Fax:
Practice Address - Street 1:108 BAYOU CT
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5413
Practice Address - Country:US
Practice Address - Phone:704-454-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered