Provider Demographics
NPI:1942595947
Name:WARREN, LAURIE ALEXANDER (MS)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ALEXANDER
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1725
Mailing Address - Country:US
Mailing Address - Phone:508-769-2636
Mailing Address - Fax:
Practice Address - Street 1:116 MECHANIC ST STE 3
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1678
Practice Address - Country:US
Practice Address - Phone:508-769-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist