Provider Demographics
NPI:1265860241
Name:WYMAN, LAUREN COON (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:COON
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 HUNTERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2773
Mailing Address - Country:US
Mailing Address - Phone:919-244-3061
Mailing Address - Fax:
Practice Address - Street 1:4350 HUNTERS CLUB DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2773
Practice Address - Country:US
Practice Address - Phone:919-244-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered