Provider Demographics
NPI:1083650022
Name:CRIST, LAURA TENGELSEN (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:TENGELSEN
Last Name:CRIST
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:TENGELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:6849 OLD WATERLOO RD
Mailing Address - Street 2:APT NO 1433
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7142
Mailing Address - Country:US
Mailing Address - Phone:240-273-8031
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVENUE
Practice Address - Street 2:JOHNS HOPKINS BAYVIEW MEDICAL CENTER CLINICAL NUTRITION
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2780
Practice Address - Country:US
Practice Address - Phone:410-550-1549
Practice Address - Fax:410-550-0650
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPX2556133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered