Healthcare Provider Details

I. General information

NPI: 1588182034
Provider Name (Legal Business Name): CAMILLE MCLAUGHLIN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 MAIN ST
ANTRIM NH
03440-3906
US

IV. Provider business mailing address

PO BOX 669
ANTRIM NH
03440-0669
US

V. Phone/Fax

Practice location:
  • Phone: 603-714-2164
  • Fax:
Mailing address:
  • Phone: 603-714-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number0914
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number0914
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0914
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number0914
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number0914
License Number StateNH
# 6
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0914
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: