Provider Demographics
NPI:1487733325
Name:DE ZANEK, LORI JEAN (RD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:DE ZANEK
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 1:6807 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8008
Mailing Address - Country:US
Mailing Address - Phone:815-675-0109
Mailing Address - Fax:
Practice Address - Street 1:4940 E STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2270
Practice Address - Country:US
Practice Address - Phone:815-227-0081
Practice Address - Fax:815-227-5854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered