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NPI Code Detail

MEDICARE: TESSA THRALLS RDN

MEDICARE: TESSA THRALLS RDN
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1417353186
Entity Type Code : Individual
Provider Name (Legal Business Name) : TESSA THRALLS RDN
Provider Business Mailing Address
First Line : 930 W HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-3927
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 930 W HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-3927
Country : US
Telephone Number : 707-269-7529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2014
Last Update Date : 11/07/2014

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Directions to “ TESSA THRALLS RDN” Practice Location

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