=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487125498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANA KNISELY RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2018
-----------------------------------------------------
Last Update Date | 08/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 CENTRAL PARK DR STE 202
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-8853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-875-2731
-----------------------------------------------------
Fax | 970-875-2780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-624-4128
-----------------------------------------------------
Fax | 970-490-4340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86101592
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------