Provider Demographics
NPI:1366948549
Name:HASWELL, SAMANTHA RAE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:HASWELL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980294
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0294
Mailing Address - Country:US
Mailing Address - Phone:804-828-0970
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 980294
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0294
Practice Address - Country:US
Practice Address - Phone:804-828-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4529133V00000X
86070843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered