Basic Information
| Provider Information | |||||||||
| NPI: | 1104158674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEDL | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RD LD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 LUBERON DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890440361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022392156 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5701 W CHARLESTON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891461256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028779514 | ||||||||
| FaxNumber: | 7023123510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2010 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 528673 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 31996DI-0 | 01 | NV | STATE OF NV LICENSURE | OTHER | 528673 | 01 | REGISTERED DIETITIAN | OTHER | 0922-4425 | 01 | CERTIFIED DIABETES EDUCATOR | OTHER |