Healthcare Provider Details

I. General information

NPI: 1619206182
Provider Name (Legal Business Name): RACHEL LEIGH WHITE RD CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2009
Last Update Date: 12/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 S 4TH ST
RICHMOND IN
47374-5408
US

IV. Provider business mailing address

328 S 4TH ST
RICHMOND IN
47374-5408
US

V. Phone/Fax

Practice location:
  • Phone: 765-620-8400
  • Fax: 765-779-4010
Mailing address:
  • Phone: 765-620-8400
  • Fax: 765-779-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001891A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: