Provider Demographics
NPI:1609120419
Name:NIPP, PEGGY L (MS, RD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:NIPP
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 1:15000 REDMOND DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4531
Mailing Address - Country:US
Mailing Address - Phone:775-846-2557
Mailing Address - Fax:
Practice Address - Street 1:1625 E PRATER WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8969
Practice Address - Country:US
Practice Address - Phone:775-352-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered