Individual
LORI L MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012
(651) 213-4407
Mailing address
1418 146TH LN NW, ANDOVER, MN 55304-3401
(804) 943-8507
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2435
MN
Other
Enumeration date
05/01/2006
Last updated
02/04/2015
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