Provider Demographics
NPI:1396938528
Name:ANDREWS, GINA LISA (MPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LISA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MPH, 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:WOMACK ARMY MEDICAL CENTER, REILLY ROAD
Mailing Address - Street 2:NUTRITION CARE DIVISION
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-3438
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER, REILLY ROAD
Practice Address - Street 2:NUTRITION CARE DIVISION
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered