Provider Demographics
NPI:1982003695
Name:VIKMANIS, LAURA LYNETTE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LYNETTE
Last Name:VIKMANIS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 6258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-5300
Mailing Address - Fax:937-208-5650
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-5300
Practice Address - Fax:937-208-5650
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH379110Medicare PIN