MEDICARE: REBECCA WILBURN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	787	OK

General Provider Information

NPI Number	:	1457897357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WILBURN

Provider Business Mailing Address
First Line	:	5051 S 129TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 S 129TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7004
Country	:	US
Telephone Number	:	918-582-9355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	01/16/2017

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