Provider Demographics
NPI:1154190387
Name:DILL, LAURA LEIGH (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEIGH
Last Name:DILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:16 DOVE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6402
Mailing Address - Country:US
Mailing Address - Phone:501-680-9002
Mailing Address - Fax:
Practice Address - Street 1:16 DOVE CREEK CIR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6402
Practice Address - Country:US
Practice Address - Phone:501-680-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR659133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered