MEDICARE: MRS. LAUREN STURGIS RD, LD/N

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	ND 7118	FL

General Provider Information

NPI Number	:	1306204615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN STURGIS RD, LD/N

Provider Business Mailing Address
First Line	:	1304 ORANGE ISLE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1657
Country	:	US
Telephone Number	:	954-593-8090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 ORANGE ISLE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1657
Country	:	US
Telephone Number	:	954-593-8090
Fax Number	:

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	04/20/2016

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