Provider Demographics
NPI:1861184129
Name:PLUNKETT, LAUREN E (RDN CDCES)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:RDN CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 SCHEFFER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1718
Mailing Address - Country:US
Mailing Address - Phone:651-491-3481
Mailing Address - Fax:
Practice Address - Street 1:1289 SCHEFFER AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1718
Practice Address - Country:US
Practice Address - Phone:651-491-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN086002519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered