Provider Demographics
NPI:1538474515
Name:MCDONNELL, LAURIE (RDN,LDN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:B
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:742 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3038
Mailing Address - Country:US
Mailing Address - Phone:260-414-5871
Mailing Address - Fax:
Practice Address - Street 1:742 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3038
Practice Address - Country:US
Practice Address - Phone:260-414-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
IL164006160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000673900OtherANTHEM
IN000000673897OtherANTHEM
IN000000673900OtherANTHEM
INM400024539Medicare PIN