Provider Demographics
NPI:1801614409
Name:WILLMON, LORI (RD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WILLMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4922 MABLE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4029
Mailing Address - Country:US
Mailing Address - Phone:262-930-9751
Mailing Address - Fax:
Practice Address - Street 1:4922 MABLE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4029
Practice Address - Country:US
Practice Address - Phone:262-930-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered