MEDICARE: MRS. REBECCA MAURILLO RD

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	997839	MT

General Provider Information

NPI Number	:	1487206868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA MAURILLO RD

Provider Business Mailing Address
First Line	:	2203 STURNELLA LN
Second Line	:
City	:	BELGRADE
State	:	MT
Zip	:	59714-7721
Country	:	US
Telephone Number	:	512-656-7293
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 N 22ND AVE STE 2
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3153
Country	:	US
Telephone Number	:	406-282-4762
Fax Number	:

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	03/30/2023

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