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General NPI Number Information
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NPI Number | 1811853443
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Entity Type | Organization
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Legal Business Name | LAURA ROSE FUNCTIONAL NUTRITION
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 4751 MOUNT ROYAL LN
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City | CHARLOTTE
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State | NC
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Zip | 28210-4690
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Country | US
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Telephone | 607-743-6253
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Fax | 704-259-4120
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Provider Business Mailing Address
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Address Line | 4751 MOUNT ROYAL LN
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City | CHARLOTTE
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State | NC
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Zip | 28210-4690
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Country | US
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Telephone | 607-743-6253
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Fax | 704-259-4120
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Authorized Official
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Title or Position | OWNER
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Name | LAURA DRAGON
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Credential | MS, RD, LDN
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Telephone | 607-743-6253
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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 |
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License Number State |
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