Provider Demographics
NPI:1306186663
Name:GIGUERE, ALLISON MARY (MS RD LDN)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARY
Last Name:GIGUERE
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:MARY
Other - Last Name:DILZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD-N, CDN, CSOWM
Mailing Address - Street 1:633 MIDDLESEX TPKE
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1220
Mailing Address - Country:US
Mailing Address - Phone:860-388-8300
Mailing Address - Fax:
Practice Address - Street 1:633 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1220
Practice Address - Country:US
Practice Address - Phone:860-388-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001149133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306186663Medicaid