Provider Demographics
NPI:1609201953
Name:PEDERSON, RACHEL FRANCINE (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:FRANCINE
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4164
Mailing Address - Country:US
Mailing Address - Phone:515-227-7491
Mailing Address - Fax:
Practice Address - Street 1:1523 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4164
Practice Address - Country:US
Practice Address - Phone:515-227-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered