Healthcare Provider Details

I. General information

NPI: 1477221729
Provider Name (Legal Business Name): REBECCA MOORE MS, RD, LD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOMACK ARMY MEDICAL CENTER 2817 REILLY ROAD
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

5145 500TH ST SE
IOWA CITY IA
52240-8329
US

V. Phone/Fax

Practice location:
  • Phone: 225-954-8013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: