Provider Demographics
NPI:1659696086
Name:LAUGHERY, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LAUGHERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-1544
Mailing Address - Country:US
Mailing Address - Phone:641-332-2201
Mailing Address - Fax:641-332-3876
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1544
Practice Address - Country:US
Practice Address - Phone:641-332-2201
Practice Address - Fax:641-332-3876
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered