Provider Demographics
NPI:1710582465
Name:FRIESEN, GWENDOLYN FAE (RD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:FAE
Last Name:FRIESEN
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 1:23 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4845
Mailing Address - Country:US
Mailing Address - Phone:518-272-9627
Mailing Address - Fax:
Practice Address - Street 1:1938 CURRY RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3902
Practice Address - Country:US
Practice Address - Phone:518-382-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered