Active NPI
Lauren Buboltz, RDN/LDN
- Registered Dietitian
- Cary, NC
National Provider Identifier
1932591542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L004120
- Practice address
- 547 Keisler Dr
Suite 104
Cary, NC 27518-9309 - Phone
- (919) 391-6361
- NPI assigned
- Feb 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L004120 | NC | Primary |
Addresses
Primary practice location
547 Keisler Dr
Suite 104
Cary, NC 27518-9309
Mailing address
547 Keisler Dr
Suite 104
Cary, NC 27518-9309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 20, 2017 through Apr 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L004120 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443312000000",
"number": "1932591542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "547 KEISLER DR",
"address_2": "SUITE 104",
"city": "CARY",
"state": "NC",
"postal_code": "275189309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "547 KEISLER DR",
"address_2": "SUITE 104",
"city": "CARY",
"state": "NC",
"postal_code": "275189309",
"telephone_number": "919-391-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUBOLTZ",
"first_name": "LAUREN",
"credential": "RDN/LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-19",
"last_updated": "2015-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L004120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.