Healthcare Provider Details

I. General information

NPI: 1336904127
Provider Name (Legal Business Name): REBECCA LYNN HIETER E-RYT500, YACEP B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W CORBETT AVE STE 8
SWANSBORO NC
28584-9039
US

IV. Provider business mailing address

807 W CORBETT AVE STE 8
SWANSBORO NC
28584-9039
US

V. Phone/Fax

Practice location:
  • Phone: 910-325-3600
  • Fax:
Mailing address:
  • Phone: 103-253-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number45
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: