MEDICARE: MRS. LORI WASTILA RAGSDALE RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L001365	NC

General Provider Information

NPI Number	:	1861735797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI WASTILA RAGSDALE RD, LDN

Provider Business Mailing Address
First Line	:	5925 HIGH SPRING CIR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6463
Country	:	US
Telephone Number	:	919-554-4635
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 HIGH SPRING CIR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6463
Country	:	US
Telephone Number	:	919-554-4635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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