Healthcare Provider Details

I. General information

NPI: 1801022645
Provider Name (Legal Business Name): LAUREN KIME R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 N CLEVELAND AVE APT 1F
CHICAGO IL
60614-9250
US

IV. Provider business mailing address

1747 N CLEVELAND AVE APT 1F
CHICAGO IL
60614-9250
US

V. Phone/Fax

Practice location:
  • Phone: 608-213-0775
  • Fax:
Mailing address:
  • Phone: 608-213-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number164005017
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: