Provider Demographics
NPI:1083255566
Name:LAUVER, SOPHIE ROSE (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ROSE
Last Name:LAUVER
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 REGESTER AVE
Mailing Address - Street 2:
Mailing Address - City:IDLEWYLDE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1612
Mailing Address - Country:US
Mailing Address - Phone:917-863-0025
Mailing Address - Fax:
Practice Address - Street 1:1210 REGESTER AVE
Practice Address - Street 2:
Practice Address - City:IDLEWYLDE
Practice Address - State:MD
Practice Address - Zip Code:21239-1612
Practice Address - Country:US
Practice Address - Phone:917-863-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered