Individual
LAURA MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
15808 HWY 620 NORTH, SUITE 100, AUSTIN, TX 78717
(512) 731-8679
Mailing address
4432 PASADA LN, ROUND ROCK, TX 78681-1683
(512) 731-8679
(512) 238-1946
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT05397
TX
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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