Provider Demographics
NPI:1518569268
Name:GAYNOR, ELIZABETH (MASTER'S OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:MASTER'S OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10407 SE 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7519
Mailing Address - Country:US
Mailing Address - Phone:646-234-2882
Mailing Address - Fax:
Practice Address - Street 1:333 NE RUSSELL ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3763
Practice Address - Country:US
Practice Address - Phone:646-234-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist