MEDICARE: LAUREN COSTIGAN RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86092770	MI

General Provider Information

NPI Number	:	1326735358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN COSTIGAN RDN

Provider Business Mailing Address
First Line	:	48553 SHADY GLEN CT
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2563
Country	:	US
Telephone Number	:	586-339-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	48553 SHADY GLEN CT
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2563
Country	:	US
Telephone Number	:	586-339-7527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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Directions to “ LAUREN COSTIGAN RDN” Practice Location

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