Provider Demographics
NPI:1083476741
Name:REEVES, LORA GAHAGAN EDDY (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:GAHAGAN EDDY
Last Name:REEVES
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:GAHAGAN
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2623
Mailing Address - Country:US
Mailing Address - Phone:843-685-2058
Mailing Address - Fax:
Practice Address - Street 1:207 AVENUE G
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2623
Practice Address - Country:US
Practice Address - Phone:843-685-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered