Provider Demographics
NPI:1720371941
Name:GUMPF, NICOLE M (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:GUMPF
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FRIENDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9704
Mailing Address - Country:US
Mailing Address - Phone:724-775-7100
Mailing Address - Fax:
Practice Address - Street 1:246 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9704
Practice Address - Country:US
Practice Address - Phone:724-775-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004492133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered