Provider Demographics
NPI:1174756084
Name:HUMMEL, ROCHELLE MARIE (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:MARIE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2720
Mailing Address - Country:US
Mailing Address - Phone:315-569-5350
Mailing Address - Fax:
Practice Address - Street 1:138 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2720
Practice Address - Country:US
Practice Address - Phone:315-569-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered