Provider Demographics
NPI:1689632465
Name:MALYAR, LAURIE A (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:MALYAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6251
Mailing Address - Country:US
Mailing Address - Phone:423-753-5854
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN VAMC
Practice Address - Street 2:NUTRITION AND FOOD SERVICES 120
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3402
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered