Provider Demographics
NPI:1104339100
Name:GANGITANO, JANE (CNS)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GANGITANO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 RETAIL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0686
Mailing Address - Country:US
Mailing Address - Phone:775-600-7097
Mailing Address - Fax:
Practice Address - Street 1:3250 RETAIL DR STE 120
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0686
Practice Address - Country:US
Practice Address - Phone:510-485-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00448133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist