Doctor Name: | MRS. SUZANNE ELIZABETH GAULDIN |
NPI Number: | 1104191931 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD/LD |
License Number: | 764 |
Business Practice Address: | 12175 N 179th East Ave Collinsville, OK - 740216259 |
Business Phone Number: | 9186980965 |
Business Fax Number: | |
Mailing Address: | 12175 N 179th East Ave, COLLINSVILLE |
State: | OK |
Postal Code: | 740216259 |
Phone Number: | 9186980965 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2012 |
NPI Last Update Date: | 03/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1006X |
License Number: | 764 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Metabolic |
Taxonomy Definition: |