Provider Demographics
NPI:1861047813
Name:FONS, LAURA KAY (RN, RDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:FONS
Suffix:
Gender:F
Credentials:RN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S76W12816 CAMBRIDGE CT E
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-4004
Mailing Address - Country:US
Mailing Address - Phone:414-412-2812
Mailing Address - Fax:
Practice Address - Street 1:S76W12816 CAMBRIDGE CT E
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-4004
Practice Address - Country:US
Practice Address - Phone:414-412-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1448133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal