Provider Demographics
NPI:1386053908
Name:RHODES, TAMARA B (RD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:B
Last Name:RHODES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:B
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-221-6258
Mailing Address - Fax:717-221-6266
Practice Address - Street 1:101 WASHINGTON ST
Practice Address - Street 2:LEARNING INSTITUTE
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1675
Practice Address - Country:US
Practice Address - Phone:717-221-6258
Practice Address - Fax:717-221-6266
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1073198133V00000X
PADN005316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102963861Medicaid
PA102963861Medicaid