Provider Demographics
NPI:1376575522
Name:BRADLEY, GAIL ANN (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 WEST MOANA LANE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-7801
Mailing Address - Country:US
Mailing Address - Phone:775-772-6840
Mailing Address - Fax:
Practice Address - Street 1:720 TAHOE ST STE C
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1700
Practice Address - Country:US
Practice Address - Phone:775-772-6849
Practice Address - Fax:833-371-1467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40354-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered