Provider Demographics
NPI:1043693856
Name:HATFIELD, LAURA (RD, CSP, LD/N)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:RD, CSP, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 ISALND INN ROAD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-5612
Mailing Address - Country:US
Mailing Address - Phone:239-994-3375
Mailing Address - Fax:239-343-5659
Practice Address - Street 1:3101 ISALND INN ROAD
Practice Address - Street 2:UNIT #1
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-5612
Practice Address - Country:US
Practice Address - Phone:239-994-3375
Practice Address - Fax:239-343-5659
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2713133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric