Provider Demographics
NPI:1528695244
Name:GOUR, ANNETTE QUATRANO (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:QUATRANO
Last Name:GOUR
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:QUATRANO
Other - Last Name:GOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:206 COREY ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD STE 9
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2185
Practice Address - Country:US
Practice Address - Phone:417-637-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered