Provider Demographics
NPI:1255523882
Name:PEITZMEIER, GAIL ANNE (EDD, RD, LD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANNE
Last Name:PEITZMEIER
Suffix:
Gender:F
Credentials:EDD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11594 MAJESTIC WAY SE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:IN
Mailing Address - Zip Code:47117-8079
Mailing Address - Country:US
Mailing Address - Phone:502-314-4331
Mailing Address - Fax:
Practice Address - Street 1:11594 MAJESTIC WAY SE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:IN
Practice Address - Zip Code:47117-8079
Practice Address - Country:US
Practice Address - Phone:502-314-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered