Provider Demographics
NPI:1053036186
Name:CICCONE, LORNA CARYL (ND)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:CARYL
Last Name:CICCONE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28620 FM 963
Mailing Address - Street 2:
Mailing Address - City:OAKALLA
Mailing Address - State:TX
Mailing Address - Zip Code:78608-1056
Mailing Address - Country:US
Mailing Address - Phone:512-284-3655
Mailing Address - Fax:
Practice Address - Street 1:28620 FM 963
Practice Address - Street 2:
Practice Address - City:OAKALLA
Practice Address - State:TX
Practice Address - Zip Code:78608-1056
Practice Address - Country:US
Practice Address - Phone:512-284-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath