Provider Demographics
NPI:1225360936
Name:BRISCOE, STACY ANNE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANNE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 KUENZLI ST
Mailing Address - Street 2:RSTHC DIABETES PREVENTION PROGRAM
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1117
Mailing Address - Country:US
Mailing Address - Phone:775-334-4305
Mailing Address - Fax:775-334-4353
Practice Address - Street 1:1715 KUENZLI ST
Practice Address - Street 2:RSTHC DIABETES PREVENTION PROGRAM
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1117
Practice Address - Country:US
Practice Address - Phone:775-334-4305
Practice Address - Fax:775-334-4353
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL979831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid
NV004716904Medicaid