Provider Demographics
NPI:1467099887
Name:HODGES, LAUREN IEZZI (MS, RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:IEZZI
Last Name:HODGES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:IEZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:1607 WOOD GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3963
Mailing Address - Country:US
Mailing Address - Phone:804-658-7250
Mailing Address - Fax:
Practice Address - Street 1:1607 WOOD GROVE CIR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-3963
Practice Address - Country:US
Practice Address - Phone:804-658-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86150972133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty