Healthcare Provider Details

I. General information

NPI: 1063768273
Provider Name (Legal Business Name): JODI LYNN FENNELL NBHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 PROFESSIONAL CIR STE 125
RENO NV
89521-3100
US

IV. Provider business mailing address

PO BOX 2743
CARSON CITY NV
89702-2743
US

V. Phone/Fax

Practice location:
  • Phone: 775-332-8332
  • Fax:
Mailing address:
  • Phone: 775-293-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number820212926
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: