Provider Demographics
NPI:1376053918
Name:BRUNERO, LAURA ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BRUNERO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PILGRIM AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4215
Mailing Address - Country:US
Mailing Address - Phone:401-787-4022
Mailing Address - Fax:401-244-7272
Practice Address - Street 1:144 PILGRIM AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-4215
Practice Address - Country:US
Practice Address - Phone:401-787-4022
Practice Address - Fax:401-244-7272
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI86042672133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered