Healthcare Provider Details

I. General information

NPI: 1932810777
Provider Name (Legal Business Name): LAURA VIGNEAU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LINCOLN ST APT 320
HINGHAM MA
02043-1771
US

IV. Provider business mailing address

319 LINCOLN ST APT 320
HINGHAM MA
02043-1771
US

V. Phone/Fax

Practice location:
  • Phone: 781-752-5182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNU1447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: