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General NPI Number Information
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NPI Number | 1598818619
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Entity Type | Individual
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Provider Name | JODI A PETTERSEN R.D.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 783 BASQUE WAY
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City | CARSON CITY
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State | NV
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Zip | 89706-7981
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Country | US
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Telephone | 775-720-3490
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Fax | 775-888-9510
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Provider Business Mailing Address
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Address Line | 783 BASQUE WAY
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City | CARSON CITY
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State | NV
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Zip | 89706-7981
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Country | US
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Telephone | 775-720-3490
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Fax | 775-888-9510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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