Provider Demographics
NPI:1922263854
Name:FRANK ELY, GERTRAUD K
Entity Type:Individual
Prefix:MRS
First Name:GERTRAUD
Middle Name:K
Last Name:FRANK ELY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GERTRAUD
Other - Middle Name:K
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11 CARLTON STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-533-0146
Mailing Address - Fax:413-533-6729
Practice Address - Street 1:11 CARLTON STR
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-533-0146
Practice Address - Fax:413-533-6729
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1341133N00000X
IL709461133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist