Provider Demographics
NPI:1225627433
Name:THAYER, GINA TRAPANI (RD, CSOWM, CNSC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:TRAPANI
Last Name:THAYER
Suffix:
Gender:F
Credentials:RD, CSOWM, CNSC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:FRANCES
Other - Last Name:TRAPANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 GRAND TETON PL
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9081
Mailing Address - Country:US
Mailing Address - Phone:970-631-5135
Mailing Address - Fax:
Practice Address - Street 1:1107 S LEMAY AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3958
Practice Address - Country:US
Practice Address - Phone:970-495-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered