MEDICARE: HEATHER ANNE TASSELMYER RDN

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1780319012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ANNE TASSELMYER RDN

Provider Business Mailing Address
First Line	:	1417 SIERRA DR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-3717
Country	:	US
Telephone Number	:	707-364-3527
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 LYNCH CREEK WAY
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2342
Country	:	US
Telephone Number	:	707-364-3527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	11/03/2025

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