Healthcare Provider Details

I. General information

NPI: 1689823056
Provider Name (Legal Business Name): LAURA ANN WILLIAMS M.S., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 NOBLE RD SUITE 101
SOUTH ABINGTON TOWNSHIP PA
18411-9406
US

IV. Provider business mailing address

242 NOBLE RD SUITE 101
SOUTH ABINGTON TOWNSHIP PA
18411-9406
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-8631
  • Fax:
Mailing address:
  • Phone: 570-586-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN000647
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDN000647
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000647
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN000647
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN000647
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN000647
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: