Provider Demographics
NPI:1083805543
Name:DEL GUERRA, LAURA MAE (RD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MAE
Last Name:DEL GUERRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RYMAN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4208
Mailing Address - Country:US
Mailing Address - Phone:406-544-8362
Mailing Address - Fax:
Practice Address - Street 1:400 RYMAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4208
Practice Address - Country:US
Practice Address - Phone:406-544-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered