Provider Demographics
NPI:1083805543
Name:DEL GUERRA, LAURA MAE (RD, CDCES)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MAE
Last Name:DEL GUERRA
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4204
Mailing Address - Country:US
Mailing Address - Phone:406-545-4614
Mailing Address - Fax:
Practice Address - Street 1:116 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4204
Practice Address - Country:US
Practice Address - Phone:406-545-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT147876133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic