Provider Demographics
NPI:1811555915
Name:MCDONALD, LAURIE BRADLEY (RD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:BRADLEY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13842 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3615
Mailing Address - Country:US
Mailing Address - Phone:602-770-8924
Mailing Address - Fax:
Practice Address - Street 1:13842 S 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3615
Practice Address - Country:US
Practice Address - Phone:602-770-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered