Healthcare Provider Details

I. General information

NPI: 1184539959
Provider Name (Legal Business Name): LAUREN MCDONALD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 ELECTRIC RD
ROANOKE VA
24018-0720
US

IV. Provider business mailing address

8220 SUNDANCE CIR
ROANOKE VA
24019-4512
US

V. Phone/Fax

Practice location:
  • Phone: 540-767-0976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86446675
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: