Provider Demographics
NPI:1982285672
Name:ANDERSON, LORA (RD CSO LDN)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD CSO LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7351
Mailing Address - Country:US
Mailing Address - Phone:815-355-7166
Mailing Address - Fax:
Practice Address - Street 1:4305 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-344-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology