Provider Demographics
NPI:1720542269
Name:HOLBROOK, RACHEL (RAE) L (MS, RDN, LD, CDCES)
Entity Type:Individual
Prefix:
First Name:RACHEL (RAE)
Middle Name:L
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MS, RDN, LD, CDCES
Other - Prefix:
Other - First Name:RACHEL (RAE)
Other - Middle Name:
Other - Last Name:KRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1858 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2566
Mailing Address - Country:US
Mailing Address - Phone:208-669-0416
Mailing Address - Fax:
Practice Address - Street 1:1858 DILLON ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2566
Practice Address - Country:US
Practice Address - Phone:086-690-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY447133V00000X
IDD-1075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered