Provider Demographics
NPI:1487125498
Name:KNISELY, LANA (RDN)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:KNISELY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:JAROSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4128
Mailing Address - Fax:970-490-4340
Practice Address - Street 1:940 CENTRAL PARK DR STE 202
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8853
Practice Address - Country:US
Practice Address - Phone:970-875-2731
Practice Address - Fax:970-875-2780
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86101592133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered