Provider Demographics
NPI:1851818744
Name:REVNAK, JANELLE (RD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:REVNAK
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 1:2156 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0905
Mailing Address - Country:US
Mailing Address - Phone:530-945-4747
Mailing Address - Fax:
Practice Address - Street 1:2156 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0905
Practice Address - Country:US
Practice Address - Phone:530-945-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063550133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic