Provider Demographics
NPI:1760039457
Name:GIBBS, LAUREN MICHELLE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:GIBBS
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 1:2365 PLAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4436
Mailing Address - Country:US
Mailing Address - Phone:307-221-2047
Mailing Address - Fax:
Practice Address - Street 1:2304 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3612
Practice Address - Country:US
Practice Address - Phone:307-221-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered