Provider Demographics
NPI:1043840937
Name:HILL, LAURIE ANNE (RDN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:HILL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 MARICOPA ST
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5240
Mailing Address - Country:US
Mailing Address - Phone:602-740-8369
Mailing Address - Fax:
Practice Address - Street 1:2660 MARICOPA ST
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5240
Practice Address - Country:US
Practice Address - Phone:602-740-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86062646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered