=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619548278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RER NUTRITION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2021
-----------------------------------------------------
Last Update Date | 07/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N MAIN ST
-----------------------------------------------------
City | OLD FORGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18518-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-241-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 N MAIN ST
-----------------------------------------------------
City | OLD FORGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18518-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-241-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIETITIAN
-----------------------------------------------------
Name | REBECCA EILEEN REED
-----------------------------------------------------
Credential | MS RDN CNSC LSN
-----------------------------------------------------
Telephone | 570-241-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------