Provider Demographics
NPI:1508378522
Name:WIDMER, LAUREN ELYSE CATLETT (RD,LD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELYSE CATLETT
Last Name:WIDMER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 MAJESTIC CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9670
Mailing Address - Country:US
Mailing Address - Phone:501-712-6943
Mailing Address - Fax:
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-202-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86088559133V00000X
AR1718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered