Basic Information
| Provider Information | |||||||||
| NPI: | 1558035063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | BS, RDN, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 MIDDLE STREET | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462980263 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088940766 | ||||||||
| FaxNumber: | 5085650097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 5347 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.