Basic Information
| Provider Information | |||||||||
| NPI: | 1306239058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSLYN | ||||||||
| FirstName: | DENISE | ||||||||
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| Credential: | R.D.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15525 N 83RD AVE | ||||||||
| Address2: | STE. 104 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853825820 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15525 N 83RD AVE | ||||||||
| Address2: | STE. 104 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853825820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778095092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2015 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 993100 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.