Provider Demographics
NPI:1063787505
Name:ABOE, REBECCA F (RD, LMNT, LD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:F
Last Name:ABOE
Suffix:
Gender:F
Credentials:RD, LMNT, LD
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:F
Other - Last Name:STARTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LMNT, LD
Mailing Address - Street 1:1702 NORTH 16TH ST.
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501
Mailing Address - Country:US
Mailing Address - Phone:712-256-7284
Mailing Address - Fax:712-256-4695
Practice Address - Street 1:1702 NORTH 16TH ST.
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501
Practice Address - Country:US
Practice Address - Phone:712-256-7284
Practice Address - Fax:712-256-4695
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE944133V00000X
IA002071133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered