Healthcare Provider Details

I. General information

NPI: 1679777254
Provider Name (Legal Business Name): REBEKAH D ALLEY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 ASHEVILLE RD
WAYNESVILLE NC
28786-3139
US

IV. Provider business mailing address

15 ENSLEY DR
CANDLER NC
28715-8551
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-6675
  • Fax: 828-452-6730
Mailing address:
  • Phone: 828-667-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: