Provider Demographics
NPI:1942019302
Name:DICKINSON, LAUREN (MS, RD, LD/N)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12249 GRIZZLY LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-2916
Mailing Address - Country:US
Mailing Address - Phone:727-364-4625
Mailing Address - Fax:
Practice Address - Street 1:12249 GRIZZLY LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2916
Practice Address - Country:US
Practice Address - Phone:727-364-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered