Provider Demographics
NPI:1083915300
Name:LAWRENCE, NICOLE SAMANTHA (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SAMANTHA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19272 CIRCLE GATE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5221
Mailing Address - Country:US
Mailing Address - Phone:301-351-7860
Mailing Address - Fax:866-231-1331
Practice Address - Street 1:19272 CIRCLE GATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5221
Practice Address - Country:US
Practice Address - Phone:301-351-7860
Practice Address - Fax:866-231-1331
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3096133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist