Provider Demographics
NPI:1194232348
Name:LEWIS, LAURIE GARY (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:GARY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:ESTELLE
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:151 SANDIFER LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5971
Mailing Address - Country:US
Mailing Address - Phone:318-443-7131
Mailing Address - Fax:318-442-2920
Practice Address - Street 1:151 SANDIFER LN
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5971
Practice Address - Country:US
Practice Address - Phone:318-443-7131
Practice Address - Fax:318-442-2920
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered