Individual
MS. KATIE J GUSTAVESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LDN CDN
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 680-1815
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 680-1815
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
137502846
CT
Other
Enumeration date
07/29/2009
Last updated
06/14/2021
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