Healthcare Provider Details

I. General information

NPI: 1316346042
Provider Name (Legal Business Name): LAURI LANG RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 NICHOLSON RD. SUITE 2100, BUILDING 2
SEWICKLEY PA
15143
US

IV. Provider business mailing address

2607 NICHOLSON RD. SUITE 2100, BUILDING 2
SEWICKLEY PA
15143
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax:
Mailing address:
  • Phone: 724-934-3905
  • Fax: 724-934-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN002236
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: