Provider Demographics
NPI:1861735797
Name:RAGSDALE, LORI WASTILA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:WASTILA
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 HIGH SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6463
Mailing Address - Country:US
Mailing Address - Phone:919-554-4635
Mailing Address - Fax:
Practice Address - Street 1:5925 HIGH SPRING CIR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6463
Practice Address - Country:US
Practice Address - Phone:919-554-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001365133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered