Provider Demographics
NPI:1851939136
Name:TREIS, GLORIA JEAN (RDN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:TREIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 N ASSEMBLY ST # MS 120
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6197
Mailing Address - Country:US
Mailing Address - Phone:509-434-7244
Mailing Address - Fax:
Practice Address - Street 1:4815 N ASSEMBLY ST # MS 120
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6197
Practice Address - Country:US
Practice Address - Phone:509-434-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1038082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered