Provider Demographics
NPI:1629436712
Name:CREASY, LAUREN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:CREASY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 RUTGERS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1330
Mailing Address - Country:US
Mailing Address - Phone:512-659-8454
Mailing Address - Fax:
Practice Address - Street 1:7808 RUTGERS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1330
Practice Address - Country:US
Practice Address - Phone:512-659-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83479133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered