Provider Demographics
NPI:1790232288
Name:SHORTHOUSE, RACHEL ANN (MPH, MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:SHORTHOUSE
Suffix:
Gender:F
Credentials:MPH, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MEDICINE WAY ROAD
Mailing Address - Street 2:SAN CARLOS APACHE HEALTHCARE CORP
Mailing Address - City:PERIDOT
Mailing Address - State:AZ
Mailing Address - Zip Code:85542
Mailing Address - Country:US
Mailing Address - Phone:928-475-1469
Mailing Address - Fax:
Practice Address - Street 1:103 MEDICINE WAY ROAD
Practice Address - Street 2:SAN CARLOS APACHE HEALTHCARE CORP
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered