Provider Demographics
NPI:1194985820
Name:WATKINS, LAURA (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE G-11
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-287-7804
Mailing Address - Fax:804-287-7178
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE G-11
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-287-7804
Practice Address - Fax:804-287-7178
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN