Provider Demographics
NPI:1669891487
Name:WILTHEISS, GINA A (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:A
Last Name:WILTHEISS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:A
Other - Last Name:MOENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:700 S STANFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2569
Practice Address - Country:US
Practice Address - Phone:937-339-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7087133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210963Medicaid
OH0210963Medicaid