Provider Demographics
NPI:1487429619
Name:ROCKENBACH, SHAE KRISTINE (RD)
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:KRISTINE
Last Name:ROCKENBACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:KRISTINE
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1945 NW ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3702
Mailing Address - Country:US
Mailing Address - Phone:208-691-4837
Mailing Address - Fax:
Practice Address - Street 1:835 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5512
Practice Address - Country:US
Practice Address - Phone:208-691-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86065857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered