Provider Demographics
NPI:1124785928
Name:ALANIS HERNANDEZ, LORI (RDN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ALANIS HERNANDEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 GRANDSTAND DR
Mailing Address - Street 2:
Mailing Address - City:LASCASSAS
Mailing Address - State:TN
Mailing Address - Zip Code:37085-4360
Mailing Address - Country:US
Mailing Address - Phone:229-560-2104
Mailing Address - Fax:
Practice Address - Street 1:2021 GRANDSTAND DR
Practice Address - Street 2:
Practice Address - City:LASCASSAS
Practice Address - State:TN
Practice Address - Zip Code:37085-4360
Practice Address - Country:US
Practice Address - Phone:229-560-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86111141OtherCDR