Provider Demographics
NPI:1598455495
Name:LATIOLAIS, LAURIE MARIE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:LATIOLAIS
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 1:4704 AMBASSADOR CAFFERY PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6908
Mailing Address - Country:US
Mailing Address - Phone:337-257-1071
Mailing Address - Fax:
Practice Address - Street 1:4704 AMBASSADOR CAFFERY PKWY FL 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6908
Practice Address - Country:US
Practice Address - Phone:337-257-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered