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General NPI Number Information
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NPI Number | 1831870971
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Entity Type | Individual
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Provider Name | GWENDOLYN M HULLETTE MS NUT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 11806 41ST AVE NW
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City | GIG HARBOR
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State | WA
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Zip | 98332-7810
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Country | US
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Telephone | 360-808-9259
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Fax |
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Provider Business Mailing Address
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Address Line | 5114 POINT FOSDICK DR STE F-1019
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City | GIG HARBOR
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State | WA
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Zip | 98335-1733
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Country | US
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Telephone | 253-363-9758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 61037509
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License Number State | WA
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