Provider Demographics
NPI:1669586533
Name:STALTERS, GRETCHEN D'ANN
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:D'ANN
Last Name:STALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STONY FIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1145
Mailing Address - Country:US
Mailing Address - Phone:508-285-9383
Mailing Address - Fax:
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE B-2
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1161
Practice Address - Country:US
Practice Address - Phone:401-333-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00363133V00000X
MA2464133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered