Provider Demographics
NPI:1700069788
Name:DEVERSE, LAURA ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:DEVERSE
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2168
Mailing Address - Country:US
Mailing Address - Phone:775-445-8000
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL PKWY
Practice Address - Street 2:NUTRITIONAL SERVICES
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4625
Practice Address - Country:US
Practice Address - Phone:775-445-8035
Practice Address - Fax:775-888-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816922133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic