Provider Demographics
NPI:1063772978
Name:GAUTHIER, JACQUELINE NICOLE MARY (CGC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NICOLE MARY
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VUMC MEDICAL GENETICS
Mailing Address - Street 2:DD-2205 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-322-7602
Mailing Address - Fax:615-343-9951
Practice Address - Street 1:VUMC MEDICAL GENETICS
Practice Address - Street 2:DD-2205 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-7602
Practice Address - Fax:615-343-9951
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNGC0000000049170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS