Provider Demographics
NPI:1497406896
Name:VARNI, MARISSA (RD, LD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:VARNI
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 1:1216 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1897
Mailing Address - Country:US
Mailing Address - Phone:530-575-9228
Mailing Address - Fax:
Practice Address - Street 1:1216 TURNBERRY DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-1897
Practice Address - Country:US
Practice Address - Phone:530-575-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39490-DI-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered