Healthcare Provider Details

I. General information

NPI: 1730545781
Provider Name (Legal Business Name): REBECCA R SAUSELEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 N GEORGE ST
YORK PA
17401-1108
US

IV. Provider business mailing address

PO BOX 864
ENOLA PA
17025-0864
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: MS. REBECCA R SAUSELEIN
Title or Position: OWNER
Credential: CNS
Phone: 717-480-9012