Individual
LORI A PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1744 TREVINO CIR, BOLINGBROOK, IL 60490-6607
(630) 640-7735
Mailing address
1744 TREVINO CIR, BOLINGBROOK, IL 60490-6607
(630) 640-7735
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.001896
IL
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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