Provider Demographics
NPI:1225613433
Name:LAURIE DELK NUTRITION
Entity Type:Organization
Organization Name:LAURIE DELK NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LN
Authorized Official - Phone:619-606-6212
Mailing Address - Street 1:112 W SKYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2821
Mailing Address - Country:US
Mailing Address - Phone:619-606-6212
Mailing Address - Fax:
Practice Address - Street 1:112 W SKYHAWK DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2821
Practice Address - Country:US
Practice Address - Phone:619-606-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty