NPI 1174553515

Lawrence P Forman, RD

Practitioner Registered Dietitian Shiprock, NM

Practice location

Address: US Highway 491 North, Shiprock, NM 87420-0160
Phone: (505) 368-6204
Fax: (505) 368-6265
Mailing address: PO Box 160, Shiprock, NM 87420-0160

Registered specialties

Registered Dietitian Primary

Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence 471 (NM)

Other Dietitian, Registered providers in New Mexico →

Registry record

NPI: 1174553515
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Jul 2006
Record last updated: 14 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.