Provider Demographics
NPI:1871272518
Name:FELDHACKER, LAURA (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FELDHACKER
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 1:4815 N 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3228
Mailing Address - Country:US
Mailing Address - Phone:402-514-7838
Mailing Address - Fax:
Practice Address - Street 1:1111 S 41ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1803
Practice Address - Country:US
Practice Address - Phone:402-444-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE86082021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered