Provider Demographics
NPI:1831842517
Name:BALDWIN, RACHEL (DTR)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 E BROADWAY RD STE 101-449
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2081
Mailing Address - Country:US
Mailing Address - Phone:847-504-6730
Mailing Address - Fax:
Practice Address - Street 1:1209 E COMMODORE PL
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2105
Practice Address - Country:US
Practice Address - Phone:847-504-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86058753136A00000X
AZ171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered