Basic Information
| Provider Information | |||||||||
| NPI: | 1790728962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENFIELD | ||||||||
| FirstName: | GWEN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743409 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275320002 | ||||||||
| FaxNumber: | 7272664928 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MEASE DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346956602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277346888 | ||||||||
| FaxNumber: | 7272664913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
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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 | 133VN1006X | ND216 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.