Provider Demographics
NPI:1437978525
Name:LOVALVO, MICHELLE EIRENE (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EIRENE
Last Name:LOVALVO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2404
Mailing Address - Country:US
Mailing Address - Phone:469-682-7544
Mailing Address - Fax:
Practice Address - Street 1:5950 SHERRY LN STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6536
Practice Address - Country:US
Practice Address - Phone:469-682-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90956133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered