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General NPI Number Information
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NPI Number | 1710057666
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Entity Type | Individual
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Provider Name | DIXIE RHODES HAVLAK R.D.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1822 BLACK LAKE BLVD SW SUITE 102-C
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City | OLYMPIA
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State | WA
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Zip | 98512-5628
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Country | US
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Telephone | 360-357-1410
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Fax | 360-357-1410
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Provider Business Mailing Address
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Address Line | 1613 CAMDEN CIR SW
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City | OLYMPIA
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State | WA
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Zip | 98512-5552
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Country | US
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Telephone | 360-357-1410
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Fax | 360-357-1410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI00000195
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License Number State | WA
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