Healthcare Provider Details

I. General information

NPI: 1033622253
Provider Name (Legal Business Name): JANA MARLENE AILES RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 SIERRA ROSE DR
RENO NV
89511-2072
US

IV. Provider business mailing address

1949 HAMILTON AVE
CARSON CITY NV
89706-2724
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-4550
  • Fax: 775-322-4775
Mailing address:
  • Phone: 775-636-1409
  • Fax: 775-841-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number920419
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: