Provider Demographics
NPI:1013668441
Name:ROUGHTON, LAURA (MSACN, CN CANIDATE)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROUGHTON
Suffix:
Gender:F
Credentials:MSACN, CN CANIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9434
Mailing Address - Country:US
Mailing Address - Phone:734-623-9068
Mailing Address - Fax:
Practice Address - Street 1:1201 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9434
Practice Address - Country:US
Practice Address - Phone:734-216-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education