Basic Information
| Provider Information | |||||||||
| NPI: | 1881614857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUTERJUNG | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1614 E NORRIS DR | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613503681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1584342273 | ||||||||
| FaxNumber: | 8154330067 | ||||||||
| Practice Location | |||||||||
| Address1: | 1614 E NORRIS DR | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613503681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154342273 | ||||||||
| FaxNumber: | 8154330067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164000314 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.