1750687547 NPI number — MRS. REBECCA E. CUSHING RD CD

Table of content: MRS. REBECCA E. CUSHING RD CD (NPI 1750687547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750687547 NPI number — MRS. REBECCA E. CUSHING RD CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUSHING
Provider First Name:
REBECCA
Provider Middle Name:
E.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUSHING
Provider Other First Name:
BECKY
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD CD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750687547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 N 500 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84604-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-354-8225
Provider Business Mailing Address Fax Number:
801-429-8150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 N 500 W
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-429-0610
Provider Business Practice Location Address Fax Number:
801-429-0629
Provider Enumeration Date:
01/27/2011

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: 174H00000X , with the licence number:  103367-4901 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 103367-4901 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00373731 . This is a "AMERICAN DIETETIC ASSOCIATION" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 103367-4901 . This is a "UTAH STATE LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com