Provider Demographics
NPI:1033407473
Name:LAWRENCE, LEANNE (RD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3940
Mailing Address - Country:US
Mailing Address - Phone:732-283-1900
Mailing Address - Fax:732-791-9566
Practice Address - Street 1:2525 NW LOVEJOY ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2864
Practice Address - Country:US
Practice Address - Phone:503-847-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1024913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered