Provider Demographics
NPI:1679688501
Name:GUISE, SALLY MARLER (RD CDE)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MARLER
Last Name:GUISE
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2790
Mailing Address - Fax:717-339-2771
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:STE 205
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2790
Practice Address - Fax:717-339-2771
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03405133V00000X
PADN006151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564266FLTMedicare PIN