Provider Demographics
NPI:1003143322
Name:LAURA DOLFIN NUTRITION CONSULTING LLC
Entity Type:Organization
Organization Name:LAURA DOLFIN NUTRITION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DOLFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CD
Authorized Official - Phone:920-912-1007
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:WI
Mailing Address - Zip Code:53031-0065
Mailing Address - Country:US
Mailing Address - Phone:920-912-1007
Mailing Address - Fax:
Practice Address - Street 1:220 S BUSINESS PARK DR STE A4
Practice Address - Street 2:
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1586
Practice Address - Country:US
Practice Address - Phone:920-912-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2048-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty