Provider Demographics
NPI:1326735358
Name:COSTIGAN, LAUREN (RDN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COSTIGAN
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 1:48553 SHADY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2563
Mailing Address - Country:US
Mailing Address - Phone:586-339-7527
Mailing Address - Fax:
Practice Address - Street 1:48553 SHADY GLEN CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2563
Practice Address - Country:US
Practice Address - Phone:586-339-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86092770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered