Provider Demographics
NPI:1568841658
Name:DORLAND-ROAN, RAICHELL LYNN (RDN, DTR, CDM, CLC)
Entity Type:Individual
Prefix:
First Name:RAICHELL
Middle Name:LYNN
Last Name:DORLAND-ROAN
Suffix:
Gender:F
Credentials:RDN, DTR, CDM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N MILES AVE
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-2323
Mailing Address - Country:US
Mailing Address - Phone:406-665-9251
Mailing Address - Fax:406-665-9238
Practice Address - Street 1:17 N MILES AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2323
Practice Address - Country:US
Practice Address - Phone:406-665-9251
Practice Address - Fax:406-665-9238
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
132700000X, 133V00000X, 174N00000X
MTMED-NUTR-LIC-41207133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN