Provider Demographics
NPI:1033433693
Name:LAINE, LAURA LYNNE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNNE
Last Name:LAINE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 STEPHENS GRANT DR
Mailing Address - Street 2:SUGAR LAND
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2245
Mailing Address - Country:US
Mailing Address - Phone:281-980-2650
Mailing Address - Fax:
Practice Address - Street 1:2511 STEPHENS GRANT DR
Practice Address - Street 2:SUGAR LAND
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2245
Practice Address - Country:US
Practice Address - Phone:281-980-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00597133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered