Provider Demographics
NPI:1588697106
Name:RUDEL, RACHEL A (LRD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:RUDEL
Suffix:
Gender:F
Credentials:LRD
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND400016OtherLHS #
ND59543Medicaid
ND6300079OtherMEDICA #
NDDA90101015504OtherPREFERRED ONE #
ND17986OtherNDBS #
ND1783078OtherAMERICA'S PPO/ARAZ #
ND6300039OtherMEDICA #
NDHP25706OtherHEALTHPARTNERS #
ND14513OtherNDBS #
MN14513OtherNDBS #
MN6300040OtherMEDICA #
ND59543Medicaid
NDHP25706OtherHEALTHPARTNERS #
ND14513OtherNDBS #
ND6300039OtherMEDICA #