Healthcare Provider Details

I. General information

NPI: 1841385440
Provider Name (Legal Business Name): GRETCHEN L ARNOLD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST. SUITE 320
PORTLAND ME
04102
US

IV. Provider business mailing address

8 RIVERSIDE FARM DR
LEE NH
03861-6215
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5522
  • Fax: 207-662-5527
Mailing address:
  • Phone: 603-568-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1520
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0681
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: