Provider Demographics
NPI:1043705577
Name:CRIM, LORRAINE DAMIANI (RDN)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:DAMIANI
Last Name:CRIM
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W GRAND CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5413
Mailing Address - Country:US
Mailing Address - Phone:928-853-3568
Mailing Address - Fax:
Practice Address - Street 1:718 W GRAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5413
Practice Address - Country:US
Practice Address - Phone:928-853-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered