1912547548 NPI number — LAURA DICKENS MENKEN MS RDN LDN

Table of content: LAURA DICKENS MENKEN MS RDN LDN (NPI 1912547548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912547548 NPI number — LAURA DICKENS MENKEN MS RDN LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENKEN
Provider First Name:
LAURA
Provider Middle Name:
DICKENS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RDN 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:
1912547548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 WILMINGTON W CHESTER PIKE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHADDS FORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19317-9011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-637-2206
Provider Business Mailing Address Fax Number:
610-227-6109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 WILMINGTON W CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 200 - #300
Provider Business Practice Location Address City Name:
CHADDS FORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19317-9011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-637-2206
Provider Business Practice Location Address Fax Number:
610-227-6109
Provider Enumeration Date:
01/12/2020

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 , with the licence number:  DN006930 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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