Organization
LAURA NYQUIST, RD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA NYQUIST RD, CLT (REGISTERED DIETITIAN)
(740) 473-6694
Entity
Organization
Contact information
Practice address
11479 S PINE DR STE 15, PARKER, CO 80134-7308
(740) 473-6694
(877) 573-6695
Mailing address
20671 WILLOWBEND LN, PARKER, CO 80138-7122
(303) 805-7801
(877) 573-6695
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
14277
CO
133V00000X
Registered Dietitian
Primary
14277
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063732287
GROUP NPI
CO
01
—
1174847552
INDIVIDUAL NPI NUMBER
—
01
—
COA100471
MEDICARE GROUP PTAN
CO
01
—
COA101925
MEDICARE INDIVIDUAL PTAN
CO
Enumeration date
06/10/2010
Last updated
01/24/2011
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