Individual
MRS. LORI WATSON BAUMGARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
165 PEPPERS FERRY RD, WYTHEVILLE, VA 24382-2070
(276) 223-5400
(276) 223-5454
Mailing address
165 PEPPERS FERRY RD, WYTHEVILLE, VA 24382-2070
(276) 223-5400
(276) 223-5454
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L003718
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2995088
MEDICARE PTAN
—
Enumeration date
02/08/2011
Last updated
08/08/2013
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