Provider Demographics
NPI:1336723089
Name:SMITH, JILLIAN RAE (RD, LD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:SMITH
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 1:450 N ARLINGTON AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4722
Mailing Address - Country:US
Mailing Address - Phone:480-510-0598
Mailing Address - Fax:
Practice Address - Street 1:450 N ARLINGTON AVE UNIT 303
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4722
Practice Address - Country:US
Practice Address - Phone:480-510-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86211840133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered