Provider Demographics
NPI:1548617277
Name:BRENGMAN, LAURIE (RDN/LD)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BRENGMAN
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17127 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-7290
Mailing Address - Country:US
Mailing Address - Phone:507-990-3825
Mailing Address - Fax:
Practice Address - Street 1:17127 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-7290
Practice Address - Country:US
Practice Address - Phone:507-990-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered