Healthcare Provider Details

I. General information

NPI: 1417027947
Provider Name (Legal Business Name): LINDSEY MAE GATZOW RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 APPLEBERRY LN
HARVEST AL
35749-4600
US

IV. Provider business mailing address

162 APPLEBERRY LN
HARVEST AL
35749-4600
US

V. Phone/Fax

Practice location:
  • Phone: 256-457-1347
  • Fax:
Mailing address:
  • Phone: 256-457-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1317
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: