Provider Demographics
NPI:1346651338
Name:WOLFE, LAURA (RDN, CDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RDN, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORNWALL CT
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2501
Mailing Address - Country:US
Mailing Address - Phone:914-220-2152
Mailing Address - Fax:
Practice Address - Street 1:3 CORNWALL CT
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2501
Practice Address - Country:US
Practice Address - Phone:518-336-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1000647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000647OtherCOMMISSION ONDIETETIC REGISTRATION