Provider Demographics
NPI:1336455393
Name:HALL, LAURA S (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6016
Mailing Address - Country:US
Mailing Address - Phone:812-285-5923
Mailing Address - Fax:812-280-5723
Practice Address - Street 1:1319 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3726
Practice Address - Country:US
Practice Address - Phone:812-283-2077
Practice Address - Fax:812-283-2411
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000888A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered