MEDICARE: LAUREN GANIM RDN

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

General Provider Information

NPI Number	:	1215613781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GANIM RDN

Provider Business Mailing Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10845 GRIFFITH PEAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1553
Country	:	US
Telephone Number	:	725-587-3268
Fax Number	:

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

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	10/10/2024

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