Provider Demographics
NPI:1053958116
Name:ELZINGA, RACHEL EVON (RD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:EVON
Last Name:ELZINGA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:EVON
Other - Last Name:DELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 NW DIVISION ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4557
Mailing Address - Country:US
Mailing Address - Phone:209-679-2704
Mailing Address - Fax:
Practice Address - Street 1:2036 NE WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3771
Practice Address - Country:US
Practice Address - Phone:541-706-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10185713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered