Healthcare Provider Details

I. General information

NPI: 1619548278
Provider Name (Legal Business Name): RER NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
OLD FORGE PA
18518-1809
US

IV. Provider business mailing address

401 N MAIN ST
OLD FORGE PA
18518-1809
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-2300
  • Fax:
Mailing address:
  • Phone: 570-241-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA EILEEN REED
Title or Position: REGISTERED DIETITIAN
Credential: MS RDN CNSC LSN
Phone: 570-241-2300