Provider Demographics
NPI:1285288563
Name:LIGUORE, LEE (RD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:LIGUORE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 HOUSEHOLDER ST APT 312
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-3437
Mailing Address - Country:US
Mailing Address - Phone:330-774-3855
Mailing Address - Fax:
Practice Address - Street 1:3604 HOUSEHOLDER ST APT 312
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-3437
Practice Address - Country:US
Practice Address - Phone:330-774-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1039440OtherRD