Provider Demographics
NPI:1639875446
Name:TOUSHA, LAURA BALDWIN (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BALDWIN
Last Name:TOUSHA
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 1:428 CICERO HILL RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-6963
Mailing Address - Country:US
Mailing Address - Phone:832-368-0734
Mailing Address - Fax:
Practice Address - Street 1:428 CICERO HILL RD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-6963
Practice Address - Country:US
Practice Address - Phone:832-368-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered