Provider Demographics
NPI:1811222722
Name:GUNDERMANN, LAURA (RD,CDE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GUNDERMANN
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0029
Mailing Address - Country:US
Mailing Address - Phone:845-615-1141
Mailing Address - Fax:845-294-4366
Practice Address - Street 1:4 HARRIMAN DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-0000
Practice Address - Country:US
Practice Address - Phone:845-615-1141
Practice Address - Fax:845-294-4366
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002712133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education