Provider Demographics
NPI:1588266654
Name:REAVES, AMANDA PAIGE (RD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:REAVES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:ANSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17751 PAPA BEAR CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-5826
Mailing Address - Country:US
Mailing Address - Phone:530-391-4650
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-466-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39779-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered