Provider Demographics
NPI:1952022303
Name:MCDEVITT, LORA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 DOBBINS MILL RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-8191
Mailing Address - Country:US
Mailing Address - Phone:336-710-5416
Mailing Address - Fax:
Practice Address - Street 1:912 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1513
Practice Address - Country:US
Practice Address - Phone:336-455-2358
Practice Address - Fax:336-290-5407
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006912133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered