Provider Demographics
NPI:1831204437
Name:DISPAS-GEBERT, DONNA (RD,CDE,LDN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DISPAS-GEBERT
Suffix:
Gender:F
Credentials:RD,CDE,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1247
Mailing Address - Country:US
Mailing Address - Phone:215-257-6319
Mailing Address - Fax:215-258-0253
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:SAINT LUKE'S QUAKERTOWN HOSPITAL
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1573
Practice Address - Country:US
Practice Address - Phone:215-538-4621
Practice Address - Fax:215-529-5274
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA086033SNGMedicare ID - Type Unspecified