Provider Demographics
NPI:1093346579
Name:LAROSEE, TAYLOR (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LAROSEE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5076 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5457
Mailing Address - Country:US
Mailing Address - Phone:515-707-9709
Mailing Address - Fax:
Practice Address - Street 1:555 S 51ST ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6967
Practice Address - Country:US
Practice Address - Phone:515-225-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered