Provider Demographics
NPI:1740211135
Name:GALE, MICHELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials: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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-0215
Mailing Address - Country:US
Mailing Address - Phone:850-621-2543
Mailing Address - Fax:
Practice Address - Street 1:307 BOATNER ROAD
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1282
Practice Address - Country:US
Practice Address - Phone:850-621-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered