Provider Demographics
NPI:1629344270
Name:KRUSE, LAUREN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MADDINGTON PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6000
Mailing Address - Country:US
Mailing Address - Phone:919-740-3888
Mailing Address - Fax:
Practice Address - Street 1:512 BRICKHAVEN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1492
Practice Address - Country:US
Practice Address - Phone:919-740-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered