Provider Demographics
NPI:1730906702
Name:KEIZER, LAURYN (RDN)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:KEIZER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-9163
Mailing Address - Country:US
Mailing Address - Phone:616-510-8060
Mailing Address - Fax:
Practice Address - Street 1:4660 136TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9452
Practice Address - Country:US
Practice Address - Phone:616-510-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered