Provider Demographics
NPI:1760629893
Name:SNELL, BLAIRE (RD)
Entity Type:Individual
Prefix:MISS
First Name:BLAIRE
Middle Name:
Last Name:SNELL
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 1:700 NORTH SPRING STREET
Mailing Address - Street 2:P.O. BOX 1010
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-3171
Mailing Address - Fax:775-726-3797
Practice Address - Street 1:700 NORTH SPRING STREET
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008-1010
Practice Address - Country:US
Practice Address - Phone:775-726-3171
Practice Address - Fax:775-726-3797
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL997076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV997076OtherCOMMISSION ON DIETETIC REGISTRATION