MEDICARE: LAURA PIERS RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2044	SC

General Provider Information

NPI Number	:	1063026680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PIERS RD, LD

Provider Business Mailing Address
First Line	:	3 TABBY SHELL RD
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5508
Country	:	US
Telephone Number	:	720-346-0945
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 TABBY SHELL RD
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5508
Country	:	US
Telephone Number	:	720-346-0945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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