MEDICARE: MRS. LAUREN ELIZABETH MCILWAINE MSC, MPH, RD, LDN

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	L005141	NC

General Provider Information

NPI Number	:	1467013631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ELIZABETH MCILWAINE MSC, MPH, RD, LDN

Provider Business Mailing Address
First Line	:	1042 WASHINGTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1258
Country	:	US
Telephone Number	:	919-781-4500
Fax Number	:	919-781-4504

Provider Business Practice Location Address
First Line	:	1042 WASHINGTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1258
Country	:	US
Telephone Number	:	919-781-4500
Fax Number	:	919-781-4504

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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