Healthcare Provider Details

I. General information

NPI: 1679688501
Provider Name (Legal Business Name): SALLY MARLER GUISE RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 V TWIN DR STE 205
GETTYSBURG PA
17325-7875
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-339-2790
  • Fax: 717-339-2771
Mailing address:
  • Phone: 717-339-2790
  • Fax: 717-339-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT03405
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: