Provider Demographics
NPI:1740770817
Name:WALEGA, LAUREN ANN (RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:WALEGA
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 1:127 N 21ST ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1406
Mailing Address - Country:US
Mailing Address - Phone:570-780-0069
Mailing Address - Fax:
Practice Address - Street 1:127 N 21ST ST APT 3R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1406
Practice Address - Country:US
Practice Address - Phone:570-780-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86025611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty