Provider Demographics
NPI:1669484895
Name:BROWN, LAURINE VENETTE (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:LAURINE
Middle Name:VENETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:LAURINE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, RD
Mailing Address - Street 1:14 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4003
Mailing Address - Country:US
Mailing Address - Phone:309-862-2547
Mailing Address - Fax:309-662-2018
Practice Address - Street 1:14 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4003
Practice Address - Country:US
Practice Address - Phone:309-862-2547
Practice Address - Fax:309-662-2018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL541122133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered