Provider Demographics
NPI:1922517929
Name:GOBLE, LAURA ANNE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:GOBLE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:109 GILPIN LN
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-7826
Mailing Address - Country:US
Mailing Address - Phone:570-241-8404
Mailing Address - Fax:
Practice Address - Street 1:2872 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-2771
Practice Address - Country:US
Practice Address - Phone:570-853-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003979133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty