| Doctor Name: | MRS. MARY GURGANUS |
| NPI Number: | 1154691772 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ND |
| License Number: | ND3705 |
| Business Practice Address: | 4979 Healthy Way Marianna, FL - 324467993 |
| Business Phone Number: | 8505262412 |
| Business Fax Number: | 8507180383 |
| Mailing Address: | 4979 Healthy Way, MARIANNA |
| State: | FL |
| Postal Code: | 324467993 |
| Phone Number: | 8505262412 |
| Fax Number: | 8507180383 |
| NPI Enumeration Date: | 01/12/2012 |
| NPI Last Update Date: | 01/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | ND3705 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |