Provider Demographics
NPI:1326437690
Name:RIEDEL, RENEE K (RD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:K
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S SANTA FE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4190
Mailing Address - Country:US
Mailing Address - Phone:785-823-7470
Mailing Address - Fax:785-823-0506
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-823-7470
Practice Address - Fax:785-823-0506
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1317133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201106640AMedicaid