Provider Demographics
NPI:1629380381
Name:TABER, LAURA M (PHD, RD, LD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:TABER
Suffix:
Gender:F
Credentials:PHD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 NICKLAUS DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3458
Mailing Address - Country:US
Mailing Address - Phone:505-353-2951
Mailing Address - Fax:
Practice Address - Street 1:273 NICKLAUS DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3458
Practice Address - Country:US
Practice Address - Phone:505-353-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0633133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03-192035-00-7OtherNEW MEXICO TRD ID #
80-0614609OtherFEDERAL ID NUMBER