Provider Demographics
NPI:1952535619
Name:PIETSZAK, LORA (RD)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:
Last Name:PIETSZAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 AMDS/SGPZ
Mailing Address - Street 2:UNIT 6180 BOX 245
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09601-0245
Mailing Address - Country:US
Mailing Address - Phone:043-430-4573
Mailing Address - Fax:
Practice Address - Street 1:31 AMDS/SGPZ
Practice Address - Street 2:UNIT 6180 BOX 245
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09601-0245
Practice Address - Country:US
Practice Address - Phone:043-430-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
841846133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered