Healthcare Provider Details

I. General information

NPI: 1962960211
Provider Name (Legal Business Name): LAUREN LANDGREBE MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 305
MOORESTOWN NJ
08057-3133
US

IV. Provider business mailing address

2000 CRAWFORD PL STE 200
MOUNT LAUREL NJ
08054-3954
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8660
  • Fax: 856-291-8661
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006667
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86069600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: