Provider Demographics
NPI:1437939345
Name:GAIL, BRANDI A (RD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:A
Last Name:GAIL
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 1:1241 ELMWOOD AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1244
Mailing Address - Country:US
Mailing Address - Phone:614-579-7575
Mailing Address - Fax:
Practice Address - Street 1:1241 ELMWOOD AVE APT 1A
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1244
Practice Address - Country:US
Practice Address - Phone:614-579-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered