Provider Demographics
NPI:1659618817
Name:MILES, LAURA LYNNE (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNNE
Last Name:MILES
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 RAMBLE LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3098
Mailing Address - Country:US
Mailing Address - Phone:512-227-6714
Mailing Address - Fax:
Practice Address - Street 1:703 RAMBLE LN UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3098
Practice Address - Country:US
Practice Address - Phone:512-227-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81249133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered