Healthcare Provider Details

I. General information

NPI: 1689169435
Provider Name (Legal Business Name): GINA GAUTHIER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5812 LOWER YORK ROAD
LAHASKA PA
18931
US

IV. Provider business mailing address

350 S LINCOLN AVE
NEWTOWN PA
18940-2122
US

V. Phone/Fax

Practice location:
  • Phone: 215-794-7880
  • Fax: 215-794-7884
Mailing address:
  • Phone: 804-839-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: