Provider Demographics
NPI:1285746412
Name:DAILEY, LAURA L (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:DAILEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:V
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2329 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3003
Mailing Address - Country:US
Mailing Address - Phone:254-752-5503
Mailing Address - Fax:
Practice Address - Street 1:2329 N 39TH ST
Practice Address - Street 2:BMA WACO - CKD SERVICES
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3003
Practice Address - Country:US
Practice Address - Phone:254-752-5503
Practice Address - Fax:254-752-4844
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04918133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ17381Medicare UPIN