Individual
LAURIE ELLEN WASKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D., LDN
Contact information
Practice address
640 MADISON AVE, SCRANTON, PA 18510-1631
(570) 961-5550
(570) 961-3844
Mailing address
15 PUBLIC SQ, SUITE 600, WILKES BARRE, PA 18701-1702
(570) 826-1777
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN000965
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007678420040
—
PA
05
—
1007678420041
—
PA
05
—
1007678420042
—
PA
05
—
1007678420044
—
PA
05
—
1027974660002
—
PA
05
—
1027974660003
—
PA
05
—
1027974660004
—
PA
Enumeration date
01/04/2013
Last updated
12/07/2015
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