Provider Demographics
NPI:1356671069
Name:MERRIFIELD, LAURA ANNE (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:MERRIFIELD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-3839
Mailing Address - Country:US
Mailing Address - Phone:319-372-5841
Mailing Address - Fax:319-372-1567
Practice Address - Street 1:2606 AVENUE L
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-3839
Practice Address - Country:US
Practice Address - Phone:319-372-5841
Practice Address - Fax:319-372-1567
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered