Provider Demographics
NPI:1942958608
Name:HAINES, TARALEE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:TARALEE
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 RIDILLA RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9538
Mailing Address - Country:US
Mailing Address - Phone:724-221-4349
Mailing Address - Fax:
Practice Address - Street 1:429 RIDILLA RD
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9538
Practice Address - Country:US
Practice Address - Phone:724-221-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty