Provider Demographics
NPI:1043827264
Name:GERTNER, DEBORAH (RDN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GERTNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 COLLYER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3411
Mailing Address - Country:US
Mailing Address - Phone:720-593-8190
Mailing Address - Fax:
Practice Address - Street 1:1239 COLLYER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3411
Practice Address - Country:US
Practice Address - Phone:720-593-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008632133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN008632OtherCOMMONWEALTH OF PENNSYLVANIA- DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OC
86032801OtherCOMMISSION ON DIETETIC REGISTRATION