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General NPI Number Information
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NPI Number | 1851818744
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Entity Type | Individual
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Provider Name | JANELLE REVNAK RD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2156 WASHINGTON AVE
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City | REDDING
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State | CA
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Zip | 96001-0905
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Country | US
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Telephone | 530-945-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 2156 WASHINGTON AVE
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City | REDDING
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State | CA
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Zip | 96001-0905
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Country | US
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Telephone | 530-945-4747
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Fax |
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 1063550
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License Number State | CA
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