Provider Demographics
NPI:1245632595
Name:MCGUIRE, LAURIE ANN (RD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8948 LONG SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5702
Mailing Address - Country:US
Mailing Address - Phone:423-339-1415
Mailing Address - Fax:423-339-1715
Practice Address - Street 1:2555 GEORGETOWN RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3562
Practice Address - Country:US
Practice Address - Phone:423-339-1415
Practice Address - Fax:423-339-1715
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN572133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered