Provider Demographics
NPI:1588368245
Name:SPEARS, LAUREN (RD, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22681 WOODWARD AVE UNIT 20575
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-7026
Mailing Address - Country:US
Mailing Address - Phone:313-643-5503
Mailing Address - Fax:888-668-6347
Practice Address - Street 1:676 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2208
Practice Address - Country:US
Practice Address - Phone:313-643-5503
Practice Address - Fax:888-668-6347
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86290681133N00000X, 133NN1002X, 133VN1006X, 133V00000X, 133V00000X, 133NN1002X, 133VN1004X, 133N00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric