Provider Demographics
NPI:1609042456
Name:RAGER, MICHELE DIANE (MS, RD-AP, LDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIANE
Last Name:RAGER
Suffix:
Gender:F
Credentials:MS, RD-AP, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HIGHLAND LN
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1040
Mailing Address - Country:US
Mailing Address - Phone:814-322-5667
Mailing Address - Fax:
Practice Address - Street 1:11565 PERRY HWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8799
Practice Address - Country:US
Practice Address - Phone:814-322-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003353133V00000X
PA930993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103066500 0001Medicaid