Provider Demographics
NPI:1841385440
Name:ARNOLD, GRETCHEN L (RD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:ARNOLD
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 1:8 RIVERSIDE FARM DR
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03861-6215
Mailing Address - Country:US
Mailing Address - Phone:603-568-2883
Mailing Address - Fax:
Practice Address - Street 1:887 CONGRESS ST.
Practice Address - Street 2:SUITE 320
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-5522
Practice Address - Fax:207-662-5527
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1520133V00000X
NH0681133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061639OtherANTHEM
ME061639OtherANTHEM