Provider Demographics
NPI:1174321723
Name:HIMMELEIN, LAURA (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HIMMELEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 GAINES RD
Mailing Address - Street 2:
Mailing Address - City:STAMPING GROUND
Mailing Address - State:KY
Mailing Address - Zip Code:40379-9722
Mailing Address - Country:US
Mailing Address - Phone:419-305-3871
Mailing Address - Fax:
Practice Address - Street 1:265 GAINES RD
Practice Address - Street 2:
Practice Address - City:STAMPING GROUND
Practice Address - State:KY
Practice Address - Zip Code:40379-9722
Practice Address - Country:US
Practice Address - Phone:419-305-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6670133V00000X
KY277216133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered