Healthcare Provider Details

I. General information

NPI: 1730192220
Provider Name (Legal Business Name): ELIZABETH LANIUS TUCKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH TUCKER GRAFF RD

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 2300A
LAFAYETTE LA
70506-6778
US

IV. Provider business mailing address

4212 W CONGRESS ST STE 2300A
LAFAYETTE LA
70506-6778
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-7801
  • Fax: 337-235-1865
Mailing address:
  • Phone: 337-237-7801
  • Fax: 337-235-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1010
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: