Provider Demographics
NPI:1033268123
Name:MUELLER, LAURA (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-915-8532
Mailing Address - Fax:708-915-8586
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2750
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-915-8532
Practice Address - Fax:708-915-8586
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL040191Medicare ID - Type UnspecifiedMNT