Provider Demographics
NPI:1871958371
Name:COLLINS, LAUREN (CD, RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 WINTER HAVEN LN APT K
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2789
Mailing Address - Country:US
Mailing Address - Phone:317-508-3427
Mailing Address - Fax:
Practice Address - Street 1:4745 WINTER HAVEN LN APT K
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2789
Practice Address - Country:US
Practice Address - Phone:317-508-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002493A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered