Healthcare Provider Details

I. General information

NPI: 1811612906
Provider Name (Legal Business Name): LISA WHITNEY RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 505
RENO NV
89502-1469
US

IV. Provider business mailing address

10528 FORT MORGAN WAY
RENO NV
89521-5295
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number32153-DI-3
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: