Provider Demographics
NPI:1154768455
Name:MCCARVER, REBECCA JANE (MS RD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:MCCARVER
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:JANE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD
Mailing Address - Street 1:282 SW 105TH TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6983
Mailing Address - Country:US
Mailing Address - Phone:208-309-0173
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE PPV 05
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-346-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10154553133V00000X
IDD-397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered