Provider Demographics
NPI:1043952096
Name:RABISH, LAUREN (RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RABISH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9734 W M 68 HWY
Mailing Address - Street 2:
Mailing Address - City:ALANSON
Mailing Address - State:MI
Mailing Address - Zip Code:49706-9605
Mailing Address - Country:US
Mailing Address - Phone:989-280-0227
Mailing Address - Fax:
Practice Address - Street 1:9734 W M 68 HWY
Practice Address - Street 2:
Practice Address - City:ALANSON
Practice Address - State:MI
Practice Address - Zip Code:49706-9605
Practice Address - Country:US
Practice Address - Phone:989-280-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86080234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered