Provider Demographics
NPI:1811447949
Name:FOGLEMAN, LAURA (RDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FOGLEMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3812
Mailing Address - Country:US
Mailing Address - Phone:602-410-1812
Mailing Address - Fax:
Practice Address - Street 1:323 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3812
Practice Address - Country:US
Practice Address - Phone:602-410-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered