Individual
MRS. LORI LYNN VANDERWEELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CSP
Contact information
Practice address
435 IONIA AVE SW STE A210, GRAND RAPIDS, MI 49503-5161
(616) 486-0385
Mailing address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(269) 760-8841
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
912475
MI
133V00000X
Registered Dietitian
912475
OH
133VN1004X
Pediatric Nutrition Registered Dietitian
912475
IN
Other
Enumeration date
11/14/2011
Last updated
09/06/2023
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