Provider Demographics
NPI:1306293055
Name:MARTIN, LAUREN NICOLE (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CHISHOLM PL STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6911
Mailing Address - Country:US
Mailing Address - Phone:972-422-9180
Mailing Address - Fax:
Practice Address - Street 1:400 CHISHOLM PL STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6911
Practice Address - Country:US
Practice Address - Phone:972-422-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86033008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367326102Medicaid