Provider Demographics
NPI:1689872244
Name:MCDONNELL, MARY ELIZABETH (MS,RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MCDONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 WIDDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5900
Mailing Address - Country:US
Mailing Address - Phone:919-812-0682
Mailing Address - Fax:
Practice Address - Street 1:401 WIDDINGTON LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5900
Practice Address - Country:US
Practice Address - Phone:919-812-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered