Provider Demographics
NPI:1386480580
Name:ROWELL, LAURA MORGAN (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MORGAN
Last Name:ROWELL
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 1:1489 RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-6149
Mailing Address - Country:US
Mailing Address - Phone:920-737-0795
Mailing Address - Fax:
Practice Address - Street 1:1489 RAVINE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6149
Practice Address - Country:US
Practice Address - Phone:920-737-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI925815133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered