Provider Demographics
NPI:1508344433
Name:DEININGER, LAUREL ANN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:DEININGER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-3009
Mailing Address - Country:US
Mailing Address - Phone:727-492-6329
Mailing Address - Fax:
Practice Address - Street 1:7880 OLIVER RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-3009
Practice Address - Country:US
Practice Address - Phone:727-492-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7592133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered