Provider Demographics
NPI:1427325836
Name:GILL, LAURA M (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:GILL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1452
Mailing Address - Country:US
Mailing Address - Phone:716-982-2295
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-3431
Practice Address - Fax:716-517-3738
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered