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General NPI Number Information
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NPI Number | 1801062633
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Entity Type | Individual
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Provider Name | LORI BUMBACO MS, RDN, CSO, LDN
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Gender | Female
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 610 ONWENTSIA AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2030
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Country | US
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Telephone | 201-787-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 610 ONWENTSIA AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2030
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Country | US
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Telephone | 201-787-2220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 943720
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number | 164.006161
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License Number State | IL
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