Provider Demographics
NPI:1902922024
Name:MCDONALD, LUVERNE MERCEDES
Entity Type:Individual
Prefix:MRS
First Name:LUVERNE
Middle Name:MERCEDES
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 RAMSGILL CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6516
Mailing Address - Country:US
Mailing Address - Phone:410-418-4515
Mailing Address - Fax:410-418-9075
Practice Address - Street 1:4710 RAMSGILL CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6516
Practice Address - Country:US
Practice Address - Phone:410-418-4515
Practice Address - Fax:410-418-9075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB00236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered