Provider Demographics
NPI:1962219360
Name:WINDOUS, HAILEY LISANN (RDN)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:LISANN
Last Name:WINDOUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:LISANN
Other - Last Name:ERNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2480 OPAL DR
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-3122
Mailing Address - Country:US
Mailing Address - Phone:775-293-2279
Mailing Address - Fax:
Practice Address - Street 1:1500 AVENUE H
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2615
Practice Address - Country:US
Practice Address - Phone:775-289-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV41073-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered