MEDICARE: LORI SINCLAIR

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	2014003574	MO

General Provider Information

NPI Number	:	1942683495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI SINCLAIR

Provider Business Mailing Address
First Line	:	4707 FERDINA CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1771
Country	:	US
Telephone Number	:	314-882-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 FERDINA CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1771
Country	:	US
Telephone Number	:	314-882-5505
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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Directions to “ LORI SINCLAIR ” Practice Location

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