Provider Demographics
NPI:1831886365
Name:TABELLO, LORI (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:TABELLO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:TABELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LORI TABELLO MS, RD
Mailing Address - Street 1:200 EXEMPLA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3370
Mailing Address - Country:US
Mailing Address - Phone:303-689-5948
Mailing Address - Fax:
Practice Address - Street 1:200 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-689-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001017133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered