Provider Demographics
NPI:1174840672
Name:MOONEY, GABRIEL DAN (RD)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:DAN
Last Name:MOONEY
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2855
Mailing Address - Country:US
Mailing Address - Phone:218-634-2120
Mailing Address - Fax:218-634-3416
Practice Address - Street 1:600 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2855
Practice Address - Country:US
Practice Address - Phone:218-634-2120
Practice Address - Fax:218-634-3416
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2912133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered