Provider Demographics
NPI:1144074386
Name:O'BRIEN, LAUREN K (RDN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:K
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 MINERAL SPRING AVE # 205
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4025
Mailing Address - Country:US
Mailing Address - Phone:516-375-3665
Mailing Address - Fax:
Practice Address - Street 1:1635 MINERAL SPRING AVE # 205
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4025
Practice Address - Country:US
Practice Address - Phone:516-375-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered