Provider Demographics
NPI:1942087663
Name:CORWIN, LAURA LYNN (RD,CLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:CORWIN
Suffix:
Gender:F
Credentials:RD,CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-2109
Mailing Address - Country:US
Mailing Address - Phone:814-323-0715
Mailing Address - Fax:
Practice Address - Street 1:3440 S HILL RD
Practice Address - Street 2:
Practice Address - City:MC KEAN
Practice Address - State:PA
Practice Address - Zip Code:16426-2109
Practice Address - Country:US
Practice Address - Phone:814-323-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA861118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered