Healthcare Provider Details

I. General information

NPI: 1871671149
Provider Name (Legal Business Name): JARED HILL DAHLE RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KADENA HEALTH & WELLNESS CENTER 18 AMDS/SGPZ
APO AP
96368-5267
US

IV. Provider business mailing address

KADENA HEALTH & WELLNESS CENTER 18 AMDS/SGPZ
APO AP
96368-5267
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-0180
  • Fax:
Mailing address:
  • Phone: 315-634-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number912883
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: