Individual
LAURIE MANKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LD
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-7468
(682) 884-4611
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1855
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT82773
TX
Other
Enumeration date
01/05/2016
Last updated
04/22/2021
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