Healthcare Provider Details

I. General information

NPI: 1376779405
Provider Name (Legal Business Name): REGINA MARIE LA TOURRETTE MS,RD,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE (120) STRATTON VA MEDICAL CENTER
ALBANY NY
12208
US

IV. Provider business mailing address

113 HOLLAND AVE (120) STRATTON VA MEDICAL CENTER
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6895
  • Fax:
Mailing address:
  • Phone: 518-626-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005409-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: