Healthcare Provider Details

I. General information

NPI: 1386719367
Provider Name (Legal Business Name): JANET M. LAURSEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16525 HOLLY CREST LN SUITE 150
HUNTERSVILLE NC
28078-4909
US

IV. Provider business mailing address

1900 RANDOLPH RD SUITE 500
CHARLOTTE NC
28207-1122
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1725
  • Fax: 704-384-1726
Mailing address:
  • Phone: 704-384-9113
  • Fax: 704-316-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: