Provider Demographics
NPI:1710312137
Name:SICKLER, LAURA L (RDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SICKLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-5913
Mailing Address - Country:US
Mailing Address - Phone:570-240-6452
Mailing Address - Fax:
Practice Address - Street 1:500 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5803
Practice Address - Country:US
Practice Address - Phone:570-371-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered