Provider Demographics
NPI:1720671134
Name:BOYLE, LAUREN (RDN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:P
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9371 CAUCUS DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3548
Mailing Address - Country:US
Mailing Address - Phone:703-346-4335
Mailing Address - Fax:
Practice Address - Street 1:9371 CAUCUS DR
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3548
Practice Address - Country:US
Practice Address - Phone:703-346-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86146068133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720671134Medicaid