Provider Demographics
NPI:1023589066
Name:LIONBERGER, RACHAEL (RDN, CD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:LIONBERGER
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 WHISTLING STRAITS DR APT 206
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2262
Mailing Address - Country:US
Mailing Address - Phone:920-410-5924
Mailing Address - Fax:
Practice Address - Street 1:2509 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2785
Practice Address - Country:US
Practice Address - Phone:715-723-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3305-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86085710OtherCOMISSION ON DIETETIC REGISTRATION