Provider Demographics
NPI:1962738179
Name:HOWELL, LAURICE ANTOINETTE (RD, LD)
Entity type:Individual
Prefix:MISS
First Name:LAURICE
Middle Name:ANTOINETTE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ARNOLDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1709
Mailing Address - Country:US
Mailing Address - Phone:770-572-3351
Mailing Address - Fax:
Practice Address - Street 1:186 ARNOLDALE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1709
Practice Address - Country:US
Practice Address - Phone:203-590-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001062OtherCT LICENSE