Provider Demographics
NPI:1447852751
Name:LEIS, CLAIRE (RDN)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:LEIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MILITARY AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4945
Mailing Address - Country:US
Mailing Address - Phone:620-789-1428
Mailing Address - Fax:
Practice Address - Street 1:100 MILITARY AVE STE 217
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4945
Practice Address - Country:US
Practice Address - Phone:620-789-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered