Basic Information
| Provider Information | |||||||||
| NPI: | 1588697106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUDEL | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LRD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 347 | ND | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | ND400016 | 01 | ND | LHS # | OTHER | 59543 | 05 | ND | MEDICAID | 6300079 | 01 | ND | MEDICA # | OTHER | DA90101015504 | 01 | ND | PREFERRED ONE # | OTHER | 17986 | 01 | ND | NDBS # | OTHER | 1783078 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 6300039 | 01 | ND | MEDICA # | OTHER | HP25706 | 01 | ND | HEALTHPARTNERS # | OTHER | 14513 | 01 | ND | NDBS # | OTHER | 14513 | 01 | MN | NDBS # | OTHER | 6300040 | 01 | MN | MEDICA # | OTHER |