Provider Demographics
NPI:1366176448
Name:GILL, LENA C (RDN, CSO, CD)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:C
Last Name:GILL
Suffix:
Gender:F
Credentials:RDN, CSO, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 GOLDING ST
Mailing Address - Street 2:
Mailing Address - City:MOXEE
Mailing Address - State:WA
Mailing Address - Zip Code:98936-9205
Mailing Address - Country:US
Mailing Address - Phone:509-833-0802
Mailing Address - Fax:
Practice Address - Street 1:2811 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3799
Practice Address - Country:US
Practice Address - Phone:509-249-5238
Practice Address - Fax:509-249-5265
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA972721133V00000X
WA974721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered