Healthcare Provider Details

I. General information

NPI: 1194596924
Provider Name (Legal Business Name): LAURA HEGEDUS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 DUNBAR WAY
JOHNSTOWN CO
80534-7481
US

IV. Provider business mailing address

3036 DUNBAR WAY
JOHNSTOWN CO
80534-7481
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-2564
  • Fax:
Mailing address:
  • Phone: 970-568-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86012685
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: