MEDICARE: MRS. GINA VANLUVEN HC

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	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1669789582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA VANLUVEN HC

Provider Business Mailing Address
First Line	:	8813 CHEYENNE WAY
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5854
Country	:	US
Telephone Number	:	435-565-2062
Fax Number	:	435-213-2803

Provider Business Practice Location Address
First Line	:	8813 CHEYENNE WAY
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5854
Country	:	US
Telephone Number	:	435-565-2062
Fax Number	:	435-213-2803

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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