Provider Demographics
NPI:1114732708
Name:ALLEN, LAURIE (MHA,RD,LDN)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MHA,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-4918
Mailing Address - Country:US
Mailing Address - Phone:985-502-1149
Mailing Address - Fax:
Practice Address - Street 1:1912 BULLARD AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-4918
Practice Address - Country:US
Practice Address - Phone:985-502-1149
Practice Address - Fax:504-584-8268
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA425133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist