# MRS. MARY LAUREN WHITESIDE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538332663
- **Gender:** F
- **Credential:** R.D, C.S.P, L.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | 003750 | GA | Yes |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | 160 | SC | — |

## Other

- **Enumeration date:** 04/09/2008
- **Last updated:** 09/27/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003124845A | — | GA |