1154751857 NPI number — MRS. LAUREN BOURGEOIS SIMON M.S., RD, LDN

Table of content: MRS. LAUREN BOURGEOIS SIMON M.S., RD, LDN (NPI 1154751857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154751857 NPI number — MRS. LAUREN BOURGEOIS SIMON M.S., RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
LAUREN
Provider Middle Name:
BOURGEOIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154751857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8490 PICARDY AVE
Provider Second Line Business Mailing Address:
SUITE 1000D
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-763-4242
Provider Business Mailing Address Fax Number:
225-763-4545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8490 PICARDY AVE
Provider Second Line Business Practice Location Address:
SUITE 1000D
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-763-4242
Provider Business Practice Location Address Fax Number:
225-763-4545
Provider Enumeration Date:
11/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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