=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407152440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE GUIDRY RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2011
-----------------------------------------------------
Last Update Date | 02/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17307 SE 272ND ST 126
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-5304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-639-2266
-----------------------------------------------------
Fax | 253-639-8464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23925 225TH WAY SE B
-----------------------------------------------------
City | MAPLE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98038-5233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-433-0123
-----------------------------------------------------
Fax | 425-433-0733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DI60172513
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------