MEDICARE: LAURA MENEFEE CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	CNS18197	MD

General Provider Information

NPI Number	:	1417600560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MENEFEE CNS

Provider Business Mailing Address
First Line	:	1732 LINDEN AVE UNIT B
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-4311
Country	:	US
Telephone Number	:	443-845-6079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 LINDEN AVE UNIT B
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-4311
Country	:	US
Telephone Number	:	443-845-6079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2022
Last Update Date	:	01/29/2022

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