MEDICARE: REBECCA ESVELT

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	DI00000247	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902851223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ESVELT

Provider Business Mailing Address
First Line	:	982 E COLUMBIA AVE
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-3316
Country	:	US
Telephone Number	:	509-685-2561
Fax Number	:	509-685-2492

Provider Business Practice Location Address
First Line	:	982 E COLUMBIA AVE
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-3316
Country	:	US
Telephone Number	:	509-685-2561
Fax Number	:	509-685-2492

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	09/05/2007

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