Provider Demographics
NPI:1306253232
Name:DEAN, RACHEL M (MPH, RDN, LDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:MPH, RDN, LDN, IBCLC
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10887 GARDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4845
Mailing Address - Country:US
Mailing Address - Phone:803-673-4946
Mailing Address - Fax:
Practice Address - Street 1:2128 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5051
Practice Address - Country:US
Practice Address - Phone:980-224-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered