Provider Demographics
NPI:1225564644
Name:GILLETTE, HEIDI (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W LAKEWAY RD STE 1004
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6349
Mailing Address - Country:US
Mailing Address - Phone:307-688-2690
Mailing Address - Fax:
Practice Address - Street 1:469 HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-9330
Practice Address - Country:US
Practice Address - Phone:307-387-9850
Practice Address - Fax:307-387-9890
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered