Provider Demographics
NPI:1750806584
Name:MCARDLE, GINA (RDN,LDN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:KOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 OAKMONT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2061
Mailing Address - Country:US
Mailing Address - Phone:570-703-7054
Mailing Address - Fax:
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-703-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered