Healthcare Provider Details

I. General information

NPI: 1578427621
Provider Name (Legal Business Name): REBECCA LYNN MORGAN RD, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N SCOTTSDALE RD APT 4056
SCOTTSDALE AZ
85257-3486
US

IV. Provider business mailing address

1301 N SCOTTSDALE RD APT 4056
SCOTTSDALE AZ
85257-3486
US

V. Phone/Fax

Practice location:
  • Phone: 605-939-4142
  • Fax:
Mailing address:
  • Phone: 605-939-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86418778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: