Healthcare Provider Details

I. General information

NPI: 1003020462
Provider Name (Legal Business Name): LAURA LYNN IACONO RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HAYES ST STE 545
NASHVILLE TN
37203-2655
US

IV. Provider business mailing address

170 E MAIN ST STE D127
HENDERSONVILLE TN
37075-2587
US

V. Phone/Fax

Practice location:
  • Phone: 629-401-4494
  • Fax:
Mailing address:
  • Phone: 615-854-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number834048
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number001919
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3950
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number001919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: