Provider Demographics
NPI:1952339897
Name:SANDERS, LAURA (MS,RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS,RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 TOPF RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8316
Mailing Address - Country:US
Mailing Address - Phone:501-650-6401
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 574
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y288OtherMNT PROVIDER