Healthcare Provider Details

I. General information

NPI: 1477238558
Provider Name (Legal Business Name): JAIMEE THERESE MARANON MS, NDTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9624 GLEN RIDGE DR
RENO NV
89521-4040
US

IV. Provider business mailing address

9624 GLEN RIDGE DR
RENO NV
89521-4040
US

V. Phone/Fax

Practice location:
  • Phone: 775-338-5897
  • Fax:
Mailing address:
  • Phone: 775-338-5897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: