Provider Demographics
NPI:1548625643
Name:GASTON, MARCY (RD)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:GASTON
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 1:3651 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-9208
Mailing Address - Country:US
Mailing Address - Phone:513-814-7828
Mailing Address - Fax:
Practice Address - Street 1:4993 STATE HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-3301
Practice Address - Country:US
Practice Address - Phone:513-814-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60622916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered