Provider Demographics
NPI:1255913208
Name:DAVID, RACHEL ANN (MPH, RDN, LD)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:ANN
Last Name:DAVID
Suffix:
Gender:F
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:PANKAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RDN, LD
Mailing Address - Street 1:1225 S GEAR AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1686
Mailing Address - Country:US
Mailing Address - Phone:816-387-1077
Mailing Address - Fax:
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-768-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030006133V00000X, 133VN1004X
IA125602133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric