Healthcare Provider Details

I. General information

NPI: 1114160413
Provider Name (Legal Business Name): LAURA FINLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 OLENTANGY RIDGE PL
POWELL OH
43065-9657
US

IV. Provider business mailing address

310 OLENTANGY RIDGE PL
POWELL OH
43065-9657
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-4213
  • Fax:
Mailing address:
  • Phone: 614-847-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: