Provider Demographics
NPI:1467013631
Name:MCILWAINE, LAUREN ELIZABETH (MSC, MPH, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:MCILWAINE
Suffix:
Gender:F
Credentials:MSC, MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1258
Mailing Address - Country:US
Mailing Address - Phone:919-781-4500
Mailing Address - Fax:919-781-4504
Practice Address - Street 1:1042 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1258
Practice Address - Country:US
Practice Address - Phone:919-781-4500
Practice Address - Fax:919-781-4504
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered