Provider Demographics
NPI:1992574214
Name:BUSH, LAUREN (RDN, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 JOHNS RD NW APT 5306
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3062
Mailing Address - Country:US
Mailing Address - Phone:315-985-1587
Mailing Address - Fax:
Practice Address - Street 1:393 JOHNS RD NW APT 5306
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3062
Practice Address - Country:US
Practice Address - Phone:315-985-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered