Healthcare Provider Details

I. General information

NPI: 1487125498
Provider Name (Legal Business Name): LANA KNISELY RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANA JAROSCH RDN

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRAL PARK DR STE 202
STEAMBOAT SPRINGS CO
80487-8853
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-875-2731
  • Fax: 970-875-2780
Mailing address:
  • Phone: 970-624-4128
  • Fax: 970-490-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86101592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: