Healthcare Provider Details

I. General information

NPI: 1831870971
Provider Name (Legal Business Name): GWENDOLYN M HULLETTE MS NUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN M HULLETTE H&W COACH

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11806 41ST AVE NW
GIG HARBOR WA
98332-7810
US

IV. Provider business mailing address

5114 POINT FOSDICK DR STE F-1019
GIG HARBOR WA
98335-1733
US

V. Phone/Fax

Practice location:
  • Phone: 360-808-9259
  • Fax:
Mailing address:
  • Phone: 253-363-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number61037509
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: