Healthcare Provider Details

I. General information

NPI: 1275179681
Provider Name (Legal Business Name): LORI NICHOLE HUANG RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MILLS AVE
GREENVILLE SC
29605-4019
US

IV. Provider business mailing address

112 LOWOOD LN
GREENVILLE SC
29605-3128
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-1844
  • Fax:
Mailing address:
  • Phone: 864-275-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number898244
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: