Provider Demographics
NPI:1275756546
Name:DONALDSON, BETHANY GUIDRY (LDN RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:GUIDRY
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LDN RD CDE
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1978 INDUSTRIAL BLVD
Mailing Address - Street 2:LEONARD J CHABERT MEDICAL CENTER EDUCATION DEPT
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363
Mailing Address - Country:US
Mailing Address - Phone:985-873-1247
Mailing Address - Fax:985-873-2176
Practice Address - Street 1:1978 INDUSTRIAL BLVD
Practice Address - Street 2:LEONARD J CHABERT MEDICAL CENTER EDUCATION DEPT
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363
Practice Address - Country:US
Practice Address - Phone:985-873-1247
Practice Address - Fax:985-873-2176
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C189Medicare ID - Type Unspecified