Healthcare Provider Details

I. General information

NPI: 1427455039
Provider Name (Legal Business Name): JESSICA ANNE REBER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY STE 611
SEATTLE WA
98122-4396
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2440
  • Fax: 206-215-2457
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60507575
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: