Provider Demographics
NPI:1659973311
Name:DZIUBYK, LAURA CATHERINE (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHERINE
Last Name:DZIUBYK
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 1:2190 S LAKE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-5807
Mailing Address - Country:US
Mailing Address - Phone:847-431-8294
Mailing Address - Fax:
Practice Address - Street 1:2190 S LAKE ST APT 11
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-5807
Practice Address - Country:US
Practice Address - Phone:847-431-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003245A133V00000X
OHLD.09320133V00000X
KY273436133V00000X
UT12466857-4901133V00000X
IL164011701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered