Provider Demographics
NPI:1265317622
Name:WANCE, LORENA (MS, RDN)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:WANCE
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 WEST STATE OF FRANKLIN ROAD STE 5
Mailing Address - Street 2:BOX 155
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6586
Mailing Address - Country:US
Mailing Address - Phone:423-285-7214
Mailing Address - Fax:
Practice Address - Street 1:110 CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2009
Practice Address - Country:US
Practice Address - Phone:423-285-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered