Provider Demographics
NPI:1407152440
Name:GUIDRY, GABRIELLE (RD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23925 225TH WAY SE
Mailing Address - Street 2:B
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5233
Mailing Address - Country:US
Mailing Address - Phone:425-433-0123
Mailing Address - Fax:425-433-0733
Practice Address - Street 1:17307 SE 272ND ST
Practice Address - Street 2:126
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5304
Practice Address - Country:US
Practice Address - Phone:253-639-2266
Practice Address - Fax:253-639-8464
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60172513133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered