Provider Demographics
NPI:1184824153
Name:LAAKE, DANA GODBOUT (LDN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:GODBOUT
Last Name:LAAKE
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11224 ORLEANS WAY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1041
Mailing Address - Country:US
Mailing Address - Phone:301-942-5505
Mailing Address - Fax:
Practice Address - Street 1:11224 ORLEANS WAY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1041
Practice Address - Country:US
Practice Address - Phone:301-942-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNOO217133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist