Provider Demographics
NPI:1083817621
Name:REDMILES, JACQUELINE NICOLE (MS, RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:REDMILES
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDE
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:NICOLE
Other - Last Name:GIANAKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:510 UPPER CHESAPEAKE DR STE 510
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4332
Mailing Address - Country:US
Mailing Address - Phone:443-643-3210
Mailing Address - Fax:443-643-3204
Practice Address - Street 1:510 UPPER CHESAPEAKE DR STE 510
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4332
Practice Address - Country:US
Practice Address - Phone:443-643-3210
Practice Address - Fax:443-643-3204
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered