Provider Demographics
NPI:1558662569
Name:NIEHOFF, LAURA ANN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:NIEHOFF
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:LEUTZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 OAKWOOD FARMS LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7906
Mailing Address - Country:US
Mailing Address - Phone:314-246-9880
Mailing Address - Fax:636-220-2406
Practice Address - Street 1:900 OAKWOOD FARMS LN
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7906
Practice Address - Country:US
Practice Address - Phone:314-246-9880
Practice Address - Fax:636-220-2406
Is Sole Proprietor?:No
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031619133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered