Provider Demographics
NPI:1073777058
Name:FUSON, LARA ENGLER (RD)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ENGLER
Last Name:FUSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 ALASKA CT APT B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8498
Mailing Address - Country:US
Mailing Address - Phone:979-574-2941
Mailing Address - Fax:
Practice Address - Street 1:208 W CASABLANCA AVE
Practice Address - Street 2:BUILDING 444
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5009
Practice Address - Country:US
Practice Address - Phone:575-784-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered