Healthcare Provider Details

I. General information

NPI: 1174066393
Provider Name (Legal Business Name): RACHELLE DEUTZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2016
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
MARSHALL MN
56258-2503
US

IV. Provider business mailing address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-8901
  • Fax:
Mailing address:
  • Phone: 507-532-9661
  • Fax: 507-537-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3750
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: