Individual
MRS. LAURA DEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1208 W MAGNOLIA AVE, 200, FORT WORTH, TX 76104-4472
(817) 995-9368
Mailing address
6333 PINIONPARK WAY, FORT WORTH, TX 76179-7751
(817) 995-9368
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT80442
TX
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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