Provider Demographics
NPI:1689844763
Name:GORMAN, ANDREA ELIZABETH (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ANGELL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4736
Mailing Address - Country:US
Mailing Address - Phone:401-829-3951
Mailing Address - Fax:
Practice Address - Street 1:90 ANGELL RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4736
Practice Address - Country:US
Practice Address - Phone:401-829-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered