Provider Demographics
NPI:1053646786
Name:GABBERT, HEATHER DIANE (MS, RD, CD, LD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANE
Last Name:GABBERT
Suffix:
Gender:F
Credentials:MS, RD, CD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3868
Mailing Address - Country:US
Mailing Address - Phone:509-228-1000
Mailing Address - Fax:509-252-9300
Practice Address - Street 1:601 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1311
Practice Address - Country:US
Practice Address - Phone:509-228-1000
Practice Address - Fax:509-252-9300
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60041578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00952817OtherRAILROAD MEDICARE
WAG8914541Medicare PIN