Healthcare Provider Details

I. General information

NPI: 1639811664
Provider Name (Legal Business Name): LAUREN POWELL RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-655-5910
  • Fax:
Mailing address:
  • Phone: 202-655-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberDI00000970
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: