Provider Demographics
NPI:1356886063
Name:TATE, RACHEL (RD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6601
Mailing Address - Country:US
Mailing Address - Phone:541-667-3517
Mailing Address - Fax:541-667-3501
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:541-667-3517
Practice Address - Fax:541-667-3501
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLDD10180961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLDD10180961OtherREGISTERED DIETITIAN