Provider Demographics
NPI:1942775184
Name:DYAL, RACHEL NELL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NELL
Last Name:DYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 COUNTY ROAD 3180
Mailing Address - Street 2:
Mailing Address - City:COOKVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75558-5074
Mailing Address - Country:US
Mailing Address - Phone:430-558-9996
Mailing Address - Fax:
Practice Address - Street 1:9040A JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:430-558-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist