Provider Demographics
NPI:1811721483
Name:LAURSEN, DIANA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LAURSEN
Suffix:
Gender:
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-5708
Mailing Address - Country:US
Mailing Address - Phone:828-736-4905
Mailing Address - Fax:
Practice Address - Street 1:37 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-5708
Practice Address - Country:US
Practice Address - Phone:828-736-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008087133V00000X
NC86360544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered