Provider Demographics
NPI:1780319012
Name:TASSELMYER, HEATHER ANNE (RDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:TASSELMYER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3717
Mailing Address - Country:US
Mailing Address - Phone:707-364-3527
Mailing Address - Fax:
Practice Address - Street 1:755 BAYWOOD DR FL 2
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5510
Practice Address - Country:US
Practice Address - Phone:707-364-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered