Provider Demographics
NPI:1417600560
Name:MENEFEE, LAURA (CNS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MENEFEE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 LINDEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4311
Mailing Address - Country:US
Mailing Address - Phone:443-845-6079
Mailing Address - Fax:
Practice Address - Street 1:1732 LINDEN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4311
Practice Address - Country:US
Practice Address - Phone:443-845-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNS18197133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist