Provider Demographics
NPI:1568127223
Name:COTTRELL, LAUREN EMILY (RDN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:EMILY
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16867 CEDARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8859
Mailing Address - Country:US
Mailing Address - Phone:517-505-3190
Mailing Address - Fax:
Practice Address - Street 1:16867 CEDARBROOK DR
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8859
Practice Address - Country:US
Practice Address - Phone:517-505-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2024-05-17
Deactivation Date:2023-11-07
Deactivation Code:
Reactivation Date:2024-05-17
Provider Licenses
StateLicense IDTaxonomies
MI86242487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered