| Doctor Name: | ABBY JAN GUSTAVESON |
| NPI Number: | 1033544580 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LD, CDE |
| License Number: | 002152 |
| Business Practice Address: | 1501 Hiland Ave Nutrition Services And Diabetes Education Clinic Burley, ID - 833182688 |
| Business Phone Number: | 2086776577 |
| Business Fax Number: | |
| Mailing Address: | 1501 Hiland Ave, Nutrition Services And Diabetes Education Clinic BURLEY |
| State: | ID |
| Postal Code: | 833182688 |
| Phone Number: | 2086776577 |
| Fax Number: | |
| NPI Enumeration Date: | 09/03/2013 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 002152 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |