Provider Demographics
NPI:1568542439
Name:POLAND, LAURA I (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:I
Last Name:POLAND
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 1:212 TALLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4547
Mailing Address - Country:US
Mailing Address - Phone:614-706-3495
Mailing Address - Fax:
Practice Address - Street 1:1245 S SUNBURY RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9444
Practice Address - Country:US
Practice Address - Phone:614-706-3495
Practice Address - Fax:855-771-8942
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3245133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO343440Medicaid
NC00633730Medicaid