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General NPI Number Information
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NPI Number | 1821966698
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Entity Type | Organization
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Legal Business Name | HER THE REBELLION LLC
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 15 HOLLY CREST CT
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City | GREENSBORO
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State | NC
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Zip | 27410-9124
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Country | US
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Telephone | 910-650-8532
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HOLLY CREST CT
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City | GREENSBORO
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State | NC
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Zip | 27410-9124
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Country | US
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Telephone | 910-650-8532
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ALEXANDRA MEI CASTOR
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Credential | REGISTERED DIETITIAN
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Telephone | 541-514-7891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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