Provider Demographics
NPI:1548557119
Name:GINGERICH, WHITNEY LEA (MA, RDN)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:LEA
Last Name:GINGERICH
Suffix:
Gender:F
Credentials:MA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57283 COUNTY ROAD 117
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7030
Mailing Address - Country:US
Mailing Address - Phone:574-238-0583
Mailing Address - Fax:
Practice Address - Street 1:57283 COUNTY ROAD 117
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-7030
Practice Address - Country:US
Practice Address - Phone:574-238-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1043187133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered