Individual
MS. LORI TRENTACOSTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETICIAN
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 549-5128
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 549-5361
(618) 549-5128
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164-000649
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078833
HEALTH ALLIANCE
IL
01
—
203887
LEGACY
IL
01
—
3932056
BCBS OF IL
IL
01
—
710000734
RR MEDICARE
IL
01
—
7210895
AETNA
IL
Enumeration date
01/04/2007
Last updated
05/03/2008
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