Provider Demographics
NPI:1831870971
Name:HULLETTE, GWENDOLYN M (MS NUT)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:HULLETTE
Suffix:
Gender:F
Credentials:MS NUT
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:M
Other - Last Name:HULLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:H&W COACH
Mailing Address - Street 1:5114 POINT FOSDICK DR STE F-1019
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1733
Mailing Address - Country:US
Mailing Address - Phone:253-363-9758
Mailing Address - Fax:
Practice Address - Street 1:11806 41ST AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7810
Practice Address - Country:US
Practice Address - Phone:360-808-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61037509133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist