Provider Demographics
NPI:1558763748
Name:MCGUERTY, AMBER B (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:B
Last Name:MCGUERTY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2751 WOODDALE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-7567
Mailing Address - Country:US
Mailing Address - Phone:225-925-3606
Mailing Address - Fax:225-925-3691
Practice Address - Street 1:2751 WOODDALE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7567
Practice Address - Country:US
Practice Address - Phone:225-925-3606
Practice Address - Fax:225-925-3691
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2345133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered