Individual
MARY MCDONELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, RN
Contact information
Practice address
365 TESCONI CIR STE B, SANTA ROSA, CA 95401-4617
(707) 575-6043
Mailing address
459 RAGLE RD, SEBASTOPOL, CA 95472-3131
(707) 829-8718
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
709757
CA
163WD0400X
Diabetes Educator Registered Nurse
499778
CA
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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