Provider Demographics
NPI:1083350656
Name:AMES, LAURA (RDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AMES
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 1:22401 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-6301
Mailing Address - Country:US
Mailing Address - Phone:302-841-2421
Mailing Address - Fax:
Practice Address - Street 1:22401 PARK AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-6301
Practice Address - Country:US
Practice Address - Phone:302-841-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty