Provider Demographics
NPI:1902323264
Name:THOMAS, LAUREN (MS RD CSSD LD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS RD CSSD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 N GLEBE RD APT 2015
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4163
Mailing Address - Country:US
Mailing Address - Phone:203-240-5726
Mailing Address - Fax:
Practice Address - Street 1:7701 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3822
Practice Address - Country:US
Practice Address - Phone:203-240-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01073852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered