Provider Demographics
NPI:1952940934
Name:PALMER, LAURA (MS, RDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 BIRCHFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7110
Mailing Address - Country:US
Mailing Address - Phone:704-591-0773
Mailing Address - Fax:
Practice Address - Street 1:469 HOSPITAL DR STE E
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4779
Practice Address - Country:US
Practice Address - Phone:704-949-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered