Healthcare Provider Details

I. General information

NPI: 1154284651
Provider Name (Legal Business Name): LAURA FREEMAN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 WOODLAND DR
HAVERTOWN PA
19083-4512
US

IV. Provider business mailing address

820 WOODLAND DR
HAVERTOWN PA
19083-4512
US

V. Phone/Fax

Practice location:
  • Phone: 610-416-5039
  • Fax:
Mailing address:
  • Phone: 610-416-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License NumberDN001439
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: