Individual
LAURA LOUISE SANFORD BANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
75 FRANCIS ST # A, BOSTON, MA 02115-6110
(617) 983-7280
Mailing address
50 STANIFORD ST, STE 430, BOSTON, MA 02114-2541
(617) 726-2040
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86082245
CO
Other
Enumeration date
05/14/2020
Last updated
06/21/2021
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