Provider Demographics
NPI:1730294265
Name:KOSKI, LAURA WEGH (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WEGH
Last Name:KOSKI
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 1:339 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-6715
Mailing Address - Country:US
Mailing Address - Phone:860-584-9982
Mailing Address - Fax:
Practice Address - Street 1:842 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4065
Practice Address - Country:US
Practice Address - Phone:860-582-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000495133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered