Provider Demographics
NPI:1285821793
Name:GIFFORD, HEATHER LYNN (RD CDN CNSD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:RD CDN CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HAYNES STREET
Mailing Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-646-1222
Mailing Address - Fax:860-647-6857
Practice Address - Street 1:71 HAYNES STREET
Practice Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-646-1222
Practice Address - Fax:860-647-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered