Healthcare Provider Details

I. General information

NPI: 1003014820
Provider Name (Legal Business Name): STACEY RUTH FRATTINGER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10415 DOUBLE R BLVD
RENO NV
89521-8905
US

IV. Provider business mailing address

10415 DOUBLE R BLVD
RENO NV
89521-8905
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-2277
  • Fax: 775-829-2365
Mailing address:
  • Phone: 775-829-2277
  • Fax: 775-829-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: