Provider Demographics
NPI:1871843292
Name:WARREN, LAURA ROSE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSE
Last Name:WARREN
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 1:320 CHURCHILL CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1806
Mailing Address - Country:US
Mailing Address - Phone:270-317-2579
Mailing Address - Fax:270-639-6336
Practice Address - Street 1:320 CHURCHILL CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1806
Practice Address - Country:US
Practice Address - Phone:270-317-2579
Practice Address - Fax:270-639-6336
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered