Provider Demographics
NPI:1649456450
Name:THOMPSON, LAURA M (RD)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 CALLE LAS COLINAS
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-2712
Mailing Address - Country:US
Mailing Address - Phone:812-779-7005
Mailing Address - Fax:
Practice Address - Street 1:5653 CALLE LAS COLINAS
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-2712
Practice Address - Country:US
Practice Address - Phone:812-779-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001794A133V00000X
KYKY-2043133V00000X
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered