Basic Information
| Provider Information | |||||||||
| NPI: | 1669694691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMERE | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD, CD, CNSD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FARRANT | ||||||||
| OtherFirstName: | JUDITH | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 S 23RD ST | ||||||||
| Address2: | STE 210 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535728684 | ||||||||
| FaxNumber: | 2532840450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37000824A | IN | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | DI60694539 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.