1720531197 NPI number — MRS. REBECCA A LUNDBORG MS, RD, CD, CNSC

Table of content: MRS. REBECCA A LUNDBORG MS, RD, CD, CNSC (NPI 1720531197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720531197 NPI number — MRS. REBECCA A LUNDBORG MS, RD, CD, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNDBORG
Provider First Name:
REBECCA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CD, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JESKE
Provider Other First Name:
REBECCA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720531197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 COLUMBIA ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-386-3660
Provider Business Mailing Address Fax Number:
206-386-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 COLUMBIA ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-3660
Provider Business Practice Location Address Fax Number:
206-386-3644
Provider Enumeration Date:
08/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DI00001887 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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