Provider Demographics
NPI:1548318967
Name:GUTELIUS, CHRISTINE ROTH (RD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ROTH
Last Name:GUTELIUS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SUNSET BEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9620
Mailing Address - Country:US
Mailing Address - Phone:315-253-2200
Mailing Address - Fax:
Practice Address - Street 1:2523 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-3202
Practice Address - Country:US
Practice Address - Phone:315-834-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0780Medicare ID - Type Unspecified