Provider Demographics
NPI:1821004813
Name:MCNAMARA, LAURA (RD CDE)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 BOUGHTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9769
Mailing Address - Country:US
Mailing Address - Phone:585-341-6807
Mailing Address - Fax:585-341-6745
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-6807
Practice Address - Fax:585-341-6745
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005578ICDN133VN1006X
CDR566541133VN1006X
NY09029199163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0140059WHOtherBLUE CHOICE
NY00355266Medicaid
NYFA0638OtherPREFERRED CARE
56654NMedicare UPIN