Provider Demographics
NPI:1861169401
Name:GEORGE, LAUREN MCMANUS (RDN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MCMANUS
Last Name:GEORGE
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 1:176 GRUBB RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3504
Mailing Address - Country:US
Mailing Address - Phone:610-513-0525
Mailing Address - Fax:
Practice Address - Street 1:176 GRUBB RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3504
Practice Address - Country:US
Practice Address - Phone:610-513-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86119182133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered