Provider Demographics
NPI:1114732211
Name:RAU, HEATHER (RDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:2634 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1240
Mailing Address - Country:US
Mailing Address - Phone:571-331-2545
Mailing Address - Fax:
Practice Address - Street 1:2634 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1240
Practice Address - Country:US
Practice Address - Phone:571-331-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered