Healthcare Provider Details

I. General information

NPI: 1225077266
Provider Name (Legal Business Name): RHONDA A HAYHURST MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E REZANOF DR
KODIAK AK
99615-6602
US

IV. Provider business mailing address

1915 E REZANOF DR
KODIAK AK
99615-6602
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-3281
  • Fax: 907-486-9546
Mailing address:
  • Phone: 907-486-3281
  • Fax: 907-486-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number161
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: