Provider Demographics
NPI:1861017154
Name:CAVINESS, RACHELLE (RD, CD)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:CAVINESS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 W TAPPS DR E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8931
Mailing Address - Country:US
Mailing Address - Phone:253-232-4709
Mailing Address - Fax:
Practice Address - Street 1:4913 W TAPPS DR E
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-8931
Practice Address - Country:US
Practice Address - Phone:253-232-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61004749133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric