Provider Demographics
NPI:1275280596
Name:SUMMERLIN, LAURA M (RDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:SUMMERLIN
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 1:2500 MEADE CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2205
Mailing Address - Country:US
Mailing Address - Phone:575-740-7494
Mailing Address - Fax:
Practice Address - Street 1:1102 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4139
Practice Address - Country:US
Practice Address - Phone:785-238-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2709133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered