Provider Demographics
NPI:1922353853
Name:LAGRAIZE, AMY H (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:LAGRAIZE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 HIGHWAY 307
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8602
Mailing Address - Country:US
Mailing Address - Phone:985-665-6026
Mailing Address - Fax:
Practice Address - Street 1:29170 HEALTH UNIT ST
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-4221
Practice Address - Country:US
Practice Address - Phone:225-265-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered