Active NPI
Katie J Gustavesen, RD LDN CDN
- Registered Dietitian
- Manchester, CT
National Provider Identifier
1851522650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 137502846
- Practice address
- 71 Haynes St
Manchester, CT 06040-4131 - Phone
- (860) 680-1815
- NPI assigned
- Jul 29, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 137502846 | CT | Primary |
Addresses
Primary practice location
71 Haynes St
Manchester, CT 06040-4131
Mailing address
71 Haynes St
Manchester, CT 06040-4131
Phone (860) 680-1815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137502846 | CT | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623628800000",
"number": "1851522650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-680-1815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-680-1815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAVESEN",
"first_name": "KATIE",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "RD LDN CDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-29",
"last_updated": "2021-06-14",
"certification_date": "2021-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CT",
"license": "137502846",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.