Provider Demographics
NPI:1093460891
Name:RILEY, BENTE HEDEVANG (RDN LPN)
Entity Type:Individual
Prefix:MS
First Name:BENTE
Middle Name:HEDEVANG
Last Name:RILEY
Suffix:
Gender:F
Credentials:RDN LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2667 ENTERPRISE ROAD NEVADA EARLY INTERVENTION SERVICES
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512
Mailing Address - Country:US
Mailing Address - Phone:775-688-1341
Mailing Address - Fax:775-688-2984
Practice Address - Street 1:2667 ENTERPRISE ROAD NEVADA EARLY INTERVENTION SVCS.
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512
Practice Address - Country:US
Practice Address - Phone:775-688-1341
Practice Address - Fax:775-688-2984
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32291DI-O133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered