MEDICARE: WHOLE DIETETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1619750239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE DIETETICS LLC

Provider Business Mailing Address
First Line	:	1887 WHITNEY MESA DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2069
Country	:	US
Telephone Number	:	702-883-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 W CHEYENNE AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-8241
Country	:	US
Telephone Number	:	702-883-2838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL ELAINE SPLINTER
Credential	:	RN
Telephone Number	:	702-883-2838

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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Directions to “WHOLE DIETETICS LLC ” Practice Location

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