Provider Demographics
NPI:1275958894
Name:RESECK, HEATHER (RD, CD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RESECK
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W UNCAS RD
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9357
Mailing Address - Country:US
Mailing Address - Phone:360-385-0150
Mailing Address - Fax:
Practice Address - Street 1:922 W UNCAS RD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9357
Practice Address - Country:US
Practice Address - Phone:360-385-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000783133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered