Provider Demographics
NPI:1629413695
Name:GUNN, HEATHER ELAINE (LDN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
Last Name:GUNN
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARMONY HALL RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1832
Mailing Address - Country:US
Mailing Address - Phone:240-604-0086
Mailing Address - Fax:
Practice Address - Street 1:110 HARMONY HALL RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1832
Practice Address - Country:US
Practice Address - Phone:240-604-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3458133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist