Healthcare Provider Details

I. General information

NPI: 1093402851
Provider Name (Legal Business Name): REBECCA CHARBONNEAU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA KIRIAN RD

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 HARRIS ST STE 324
JUNEAU AK
99801-1078
US

IV. Provider business mailing address

4450 MOUNTAINSIDE DR
JUNEAU AK
99801-9560
US

V. Phone/Fax

Practice location:
  • Phone: 907-921-3748
  • Fax:
Mailing address:
  • Phone: 567-208-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number138808
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: