Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2012032792 | MO |
NPI | 1104257823 |
---|---|
Provider Name | Lauren Carter |
First Address | Troy, MO 63379-1124 |
Second Address | Troy, MO 63379-5065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2013 |
Last Update Date | 27/09/2019 |