=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043503881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA D. EBERLY RDN/CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2011
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 N 8TH AVE
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80601-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-447-1650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 N 8TH AVE
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80601-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-447-1650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 971129
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133VN1006X
-----------------------------------------------------
Taxonomy Name | Metabolic Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 971129
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 133VN1006X
-----------------------------------------------------
Taxonomy Name | Metabolic Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 33357D1-0
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 21220137
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------