Provider Demographics
NPI:1174380695
Name:GARDEA- GUERRERO, JANEAN NADINE (RD, LD)
Entity type:Individual
Prefix:
First Name:JANEAN
Middle Name:NADINE
Last Name:GARDEA- GUERRERO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JANEAN
Other - Middle Name:NADINE
Other - Last Name:GARDEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:8340 MISSION RD STE 237
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD STE 237
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1362
Practice Address - Country:US
Practice Address - Phone:816-635-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2801133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered