Provider Demographics
NPI:1427201946
Name:PETERS, LAURA D (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:PETERS
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 NE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3420
Mailing Address - Country:US
Mailing Address - Phone:954-767-0343
Mailing Address - Fax:954-527-4637
Practice Address - Street 1:634 NE 17TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3420
Practice Address - Country:US
Practice Address - Phone:954-767-0343
Practice Address - Fax:954-527-4637
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered