Provider Demographics
NPI:1225108400
Name:DAWSON, LAURA L (MAOM, DIPLAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MAOM, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-0056
Mailing Address - Country:US
Mailing Address - Phone:910-777-7307
Mailing Address - Fax:
Practice Address - Street 1:2826 BELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6506
Practice Address - Country:US
Practice Address - Phone:910-777-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02298171100000X, 174H00000X, 1744R1102X, 246Y00000X, 225500000X, 133NN1002X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator
No1744R1102XOther Service ProvidersSpecialistResearch Study
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
016303OtherNAT'L LICENSE-NCCAOM
1013971381OtherNPI-FOR FOOD PHYSICS AND BODY DYNAMICS LLC, OWNED BY L DAWSON
MDU02298OtherACUPUNCTURE LICENSING BOARD
621399OtherCCR GOVERNMENT CONTRACTING CODIFICATION
51WY9OtherCCR CAGE#