Provider Demographics
NPI:1215717095
Name:LAURA H. SMITH NUTRITION LLC
Entity type:Organization
Organization Name:LAURA H. SMITH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDCES
Authorized Official - Phone:512-359-8459
Mailing Address - Street 1:PO BOX 151735
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1735
Mailing Address - Country:US
Mailing Address - Phone:512-359-8459
Mailing Address - Fax:512-582-2957
Practice Address - Street 1:5900 BALCONES DR # 15580
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:512-359-8459
Practice Address - Fax:512-582-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty