Individual
GWEN ZUMWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-9253
(217) 258-2199
Mailing address
571 JAMES DR, CHARLESTON, IL 61920-1887
(217) 258-2199
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005410
IL
Other
Enumeration date
10/26/2009
Last updated
10/26/2009
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