Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3750 | OH |
NPI | 1104933894 |
---|---|
Provider Name | Dr. Laura R Vernallis |
First Address | Avon Lake, OH 44012-1726 |
Second Address | Rocky River, OH 44116-3437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |