Provider Demographics
NPI:1790526119
Name:GERDES, MADELINE (RDN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:GERDES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7002
Mailing Address - Country:US
Mailing Address - Phone:937-478-9170
Mailing Address - Fax:
Practice Address - Street 1:55 FEATHER CIR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7002
Practice Address - Country:US
Practice Address - Phone:937-478-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000803022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered