Provider Demographics
NPI:1265828701
Name:KING, LAURA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509B W FRIENDLY AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5509B W FRIENDLY AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4270
Practice Address - Country:US
Practice Address - Phone:336-273-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered