Provider Demographics
NPI:1144621624
Name:NIZRI, LAURA RUTH (RD, CSR, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:NIZRI
Suffix:
Gender:F
Credentials:RD, CSR, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:RAHMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S RANCHO DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4844
Mailing Address - Country:US
Mailing Address - Phone:702-877-1887
Mailing Address - Fax:702-877-4536
Practice Address - Street 1:500 S RANCHO DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4844
Practice Address - Country:US
Practice Address - Phone:702-877-1887
Practice Address - Fax:702-877-4536
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32226DI-0133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal