MEDICARE: RACHEL EMMA LUYMES RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86303528	WA

General Provider Information

NPI Number	:	1093439580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL EMMA LUYMES RD

Provider Business Mailing Address
First Line	:	1244 CORA ST SE APT 302
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98503-2373
Country	:	US
Telephone Number	:	760-805-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 24TH WAY SW STE B3
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-6033
Country	:	US
Telephone Number	:	360-754-2936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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