Provider Demographics
NPI:1679178263
Name:ELIASSON, LAUREN K (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:K
Last Name:ELIASSON
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 1:6823 PONCHA PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4370
Mailing Address - Country:US
Mailing Address - Phone:512-925-4184
Mailing Address - Fax:
Practice Address - Street 1:6823 PONCHA PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4370
Practice Address - Country:US
Practice Address - Phone:512-925-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered