Healthcare Provider Details

I. General information

NPI: 1083105217
Provider Name (Legal Business Name): REBECCA RENAE LONAM MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N EVERGREEN RD
SPOKANE VALLEY WA
99216-0819
US

IV. Provider business mailing address

1304 W 11TH AVE
SPOKANE WA
99204-4006
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-3528
  • Fax:
Mailing address:
  • Phone: 509-475-2918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60857273
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: