Provider Demographics
NPI:1952169112
Name:GAMONAL-WILLIAMSON, ELENA EMMA (RDN)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:EMMA
Last Name:GAMONAL-WILLIAMSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 GANTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9224
Mailing Address - Country:US
Mailing Address - Phone:336-260-6168
Mailing Address - Fax:
Practice Address - Street 1:614 GANTWOOD LN
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9224
Practice Address - Country:US
Practice Address - Phone:336-260-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered