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General NPI Number Information
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NPI Number | 1174321723
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Entity Type | Individual
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Provider Name | LAURA HIMMELEIN RD
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Gender | Female
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 265 GAINES RD
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City | STAMPING GROUND
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State | KY
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Zip | 40379-9722
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Country | US
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Telephone | 419-305-3871
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Fax |
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Provider Business Mailing Address
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Address Line | 265 GAINES RD
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City | STAMPING GROUND
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State | KY
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Zip | 40379-9722
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Country | US
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Telephone | 419-305-3871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 6670
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 277216
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License Number State | KY
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