MEDICARE: LAUREN CHURCH

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	:	1811716442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CHURCH

Provider Business Mailing Address
First Line	:	9100 SAN MATEO BLVD NE APT 1073
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2609
Country	:	US
Telephone Number	:	505-377-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 SAN MATEO BLVD NE APT 1073
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2609
Country	:	US
Telephone Number	:	505-377-3755
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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Directions to “ LAUREN CHURCH ” Practice Location

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