Basic Information
| Provider Information | |||||||||
| NPI: | 1841385440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 RIVERSIDE FARM DR | ||||||||
| Address2: | |||||||||
| City: | LEE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038616215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035682883 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 887 CONGRESS ST. | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076625522 | ||||||||
| FaxNumber: | 2076625527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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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 | D1520 | ME | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 0681 | NH | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 061639 | 01 | ME | ANTHEM | OTHER |