Provider Demographics
NPI:1851109482
Name:LEWIS, LAURA GLYN (RD, CNSC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GLYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:GLYN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:PO BOX 5155
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-5155
Mailing Address - Country:US
Mailing Address - Phone:231-357-4135
Mailing Address - Fax:
Practice Address - Street 1:3083 PARTERRE PL
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9008
Practice Address - Country:US
Practice Address - Phone:231-357-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic