Provider Demographics
NPI:1477398469
Name:LEVINE, GAIL E (RDN)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 INDIAN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4565
Mailing Address - Country:US
Mailing Address - Phone:503-504-9436
Mailing Address - Fax:
Practice Address - Street 1:304 INDIAN SPRINGS CT
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4565
Practice Address - Country:US
Practice Address - Phone:503-504-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered