Provider Demographics
NPI:1225721988
Name:LAWRENCE, AMBER ESPLIN (RDN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ESPLIN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7037 FIELDHURST CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5633
Mailing Address - Country:US
Mailing Address - Phone:801-703-8387
Mailing Address - Fax:
Practice Address - Street 1:7037 FIELDHURST CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5633
Practice Address - Country:US
Practice Address - Phone:801-703-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1377133V00000X
NCL007304133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered