Provider Demographics
NPI:1184630444
Name:LEICHT, NANCY (RD,CDE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LEICHT
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:#5 CASTALIA
Mailing Address - City:BLUE DIAMOND
Mailing Address - State:NV
Mailing Address - Zip Code:89004-0244
Mailing Address - Country:US
Mailing Address - Phone:702-875-1992
Mailing Address - Fax:
Practice Address - Street 1:3880 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2456
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered