Provider Demographics
NPI:1457702821
Name:ENO, LORIANN MARTHA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LORIANN
Middle Name:MARTHA
Last Name:ENO
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 1:1619 CARDINAL RDG
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3421
Mailing Address - Country:US
Mailing Address - Phone:248-587-2345
Mailing Address - Fax:248-539-0963
Practice Address - Street 1:1619 CARDINAL RDG
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3421
Practice Address - Country:US
Practice Address - Phone:248-496-2000
Practice Address - Fax:248-539-0963
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI805536133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN70820004Medicare UPIN