Provider Demographics
NPI:1386119451
Name:JACOBSEN, RACHEL PAMELA FOX (MPH RDN LD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:PAMELA FOX
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MPH RDN LD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:PAMELA
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH RDN CSP LD
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-3207
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty