Provider Demographics
NPI:1720211345
Name:DOLFIN, LAURA MAE (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MAE
Last Name:DOLFIN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:WI
Mailing Address - Zip Code:53031-0065
Mailing Address - Country:US
Mailing Address - Phone:920-912-1007
Mailing Address - Fax:
Practice Address - Street 1:220 S BUSINESS PARK DR
Practice Address - Street 2:UNIT A-4
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1585
Practice Address - Country:US
Practice Address - Phone:920-912-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2048-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered