Healthcare Provider Details

I. General information

NPI: 1831537778
Provider Name (Legal Business Name): REBECCA R SAUSELEIN MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 W MAIN ST STE 1
MOUNT JOY PA
17552-9699
US

IV. Provider business mailing address

1013 W MAIN ST STE 1
MOUNT JOY PA
17552-9699
US

V. Phone/Fax

Practice location:
  • Phone: 717-480-9012
  • Fax:
Mailing address:
  • Phone: 717-480-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN005739
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: