NPIMap

Individual provider Active NPI

Laurie Ellen Waskovich, M.S., R.D., LDN

  • Registered Dietitian
  • Scranton, PA
National Provider Identifier
1215274659
Registry record updated Dec 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN000965 Issued in PA
Practice address
640 Madison Ave
Scranton, PA 18510-1631
Phone
(570) 961-5550
Fax
(570) 961-3844
NPI assigned
Jan 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN000965 PA Primary

Addresses

Primary practice location

640 Madison Ave
Scranton, PA 18510-1631

Mailing address

15 Public SQ
Suite 600
Wilkes Barre, PA 18701-1702
Phone (570) 826-1777

Other identifiers 7

IdentifierTypeStateIssuer
1027974660003MedicaidPA
1007678420044MedicaidPA
1027974660002MedicaidPA
1027974660004MedicaidPA
1007678420041MedicaidPA
1007678420042MedicaidPA
1007678420040MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
DN000965PAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Maternal & Family Health Services Inc Past Accepting new patients
Maternal & Family Health Services, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449446400000",
    "number": "1215274659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ",
            "address_2": "SUITE 600",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011702",
            "telephone_number": "570-826-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 MADISON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185101631",
            "telephone_number": "570-961-5550",
            "fax_number": "570-961-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASKOVICH",
        "first_name": "LAURIE",
        "middle_name": "ELLEN",
        "credential": "M.S., R.D., LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2015-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN000965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027974660003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420044",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027974660002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027974660004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420041",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420042",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420040",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.