Provider Demographics
NPI:1013713098
Name:DEAN, LAURA M (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:DEAN
Suffix:
Gender:
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LISA WOOD CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8452
Mailing Address - Country:US
Mailing Address - Phone:717-698-0848
Mailing Address - Fax:
Practice Address - Street 1:1310 BALTIMORE ST STE B
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4407
Practice Address - Country:US
Practice Address - Phone:717-698-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00159133V00000X
PADN006911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered