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NPI Code Detail

MEDICARE: RAICHELL LYNN DORLAND-ROAN RDN, DTR, CDM, CLC

MEDICARE:   RAICHELL LYNN DORLAND-ROAN  RDN, DTR, CDM, CLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1132700000XDietary Manager
2133N00000XNutritionistMED-NUTR-LIC-41207MT
3133V00000XRegistered Dietitian
4174N00000XLactation Consultant (Non-RN)

General Provider Information

NPI Number : 1568841658
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAICHELL LYNN DORLAND-ROAN RDN, DTR, CDM, CLC
Provider Business Mailing Address
First Line : 17 N MILES AVE
Second Line :
City : HARDIN
State : MT
Zip : 59034-2323
Country : US
Telephone Number : 406-665-9251
Fax Number : 406-665-9238
Provider Business Practice Location Address
First Line : 17 N MILES AVE
Second Line :
City : HARDIN
State : MT
Zip : 59034-2323
Country : US
Telephone Number : 406-665-9251
Fax Number : 406-665-9238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2015
Last Update Date : 05/22/2015

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Directions to “ RAICHELL LYNN DORLAND-ROAN RDN, DTR, CDM, CLC” Practice Location

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