Healthcare Provider Details

I. General information

NPI: 1427128032
Provider Name (Legal Business Name): GAYLE ANN BOYER RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE AVE SE SUITE 2045
GRAND RAPIDS MI
49503-4600
US

IV. Provider business mailing address

300 LAFAYETTE AVE SE SUITE 2045
GRAND RAPIDS MI
49503-4600
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-5083
  • Fax:
Mailing address:
  • Phone: 616-752-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: