Provider Demographics
NPI:1801171699
Name:TEAGUE, LAUREN ROSS (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ROSS
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 ASHEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786
Mailing Address - Country:US
Mailing Address - Phone:828-452-6675
Mailing Address - Fax:828-452-6730
Practice Address - Street 1:2177 ASHEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-452-6730
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered