Provider Demographics
NPI:1841632205
Name:MALNAR, LAURA M (MBA RD LDN)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:MALNAR
Suffix:
Gender:F
Credentials:MBA RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 BEAMAN ST
Mailing Address - Street 2:PO DRAWER 260
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2603
Mailing Address - Country:US
Mailing Address - Phone:910-592-8511
Mailing Address - Fax:910-590-2321
Practice Address - Street 1:607 BEAMAN ST
Practice Address - Street 2:PO DRAWER 260
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2603
Practice Address - Country:US
Practice Address - Phone:910-592-8511
Practice Address - Fax:910-590-2321
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004114133V00000X
1015665133V00000X
SC916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered