NPI 1174553515 · live from the CMS NPI Registry
Lawrence P Forman, R.D.
Dietitian, Registered in Shiprock, NM. National Provider Identifier 1174553515, active.
NPI record
| NPI | 1174553515 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | Us Highway 491 North, Shiprock, NM 87420 |
| Practice phone | 505-368-6204 |
| Mailing address | Po Box 160, Shiprock, NM 87420 |
| Enumerated | July 3, 2006 |
| Last updated | August 14, 2008 |
| Sole proprietor | No |
| Other names | Larry Forman |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 471 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.