Doctor Name: | BONITA LILLIE |
NPI Number: | 1134305857 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD |
License Number: | 2004009119 |
Business Practice Address: | 2121 Eisenhower Ave Suite 200 Alexandria, VA - 223144698 |
Business Phone Number: | 7035190901 |
Business Fax Number: | 7035190902 |
Mailing Address: | 5412 Castle Bar Ln, ALEXANDRIA |
State: | VA |
Postal Code: | 223155519 |
Phone Number: | 7038795160 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2008 |
NPI Last Update Date: | 09/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 2004009119 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |