Healthcare Provider Details

I. General information

NPI: 1528333572
Provider Name (Legal Business Name): LAUREN HOLMES WALSH MS, RDN, LD, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

130 MARBLE CROSSING DR
WENTZVILLE MO
63385-3847
US

V. Phone/Fax

Practice location:
  • Phone: 212-589-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number14887
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2011034486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: