Provider Demographics
NPI:1295039089
Name:KING, LAUREN MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:PCSOLYAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2073 BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5103
Mailing Address - Country:US
Mailing Address - Phone:703-784-2869
Mailing Address - Fax:
Practice Address - Street 1:2073 BARNETT AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5103
Practice Address - Country:US
Practice Address - Phone:703-784-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA928884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered