Provider Demographics
NPI:1437255296
Name:GENTER, PAULINE MARION (RD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:MARION
Last Name:GENTER
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 1:600 MAYWOOD AVE
Mailing Address - Street 2:CC100
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7008
Mailing Address - Country:US
Mailing Address - Phone:507-389-6203
Mailing Address - Fax:507-389-5787
Practice Address - Street 1:600 MAYWOOD AVE
Practice Address - Street 2:CC100
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7008
Practice Address - Country:US
Practice Address - Phone:507-389-6203
Practice Address - Fax:507-389-5787
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
483373OtherNATIONAL REGISTRATION
MN1609OtherST. OF MN BOARD OF DIETIC