Individual
JUDY GOURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2204 WILBORN AVE, SOUTH BOSTON, VA 24592-1645
(434) 517-3579
Mailing address
2204 WILBORN AVE, SOUTH BOSTON, VA 24592-1645
(434) 517-3579
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
613615
VA
133V00000X
Registered Dietitian
LOOO602
NC
Other
Enumeration date
11/13/2014
Last updated
11/17/2014
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