Provider Demographics
NPI:1063475515
Name:HEGENAUER, LAURA A (RD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HEGENAUER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:FALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0608
Mailing Address - Country:US
Mailing Address - Phone:989-466-3330
Mailing Address - Fax:989-463-2540
Practice Address - Street 1:300 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1014
Practice Address - Country:US
Practice Address - Phone:989-466-3330
Practice Address - Fax:989-463-2540
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI805649OtherCOMMISSSION ON DIETETIC REGISTRATION
MI805649OtherCOMMISSSION ON DIETETIC REGISTRATION