Provider Demographics
NPI:1669118022
Name:BROWN, LAURA A (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:BROWN
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 1:8442 PRAIRIE CLOVER WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8979
Mailing Address - Country:US
Mailing Address - Phone:805-340-0302
Mailing Address - Fax:
Practice Address - Street 1:8442 PRAIRIE CLOVER WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8979
Practice Address - Country:US
Practice Address - Phone:805-340-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86199451133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered