Provider Demographics
NPI:1366714578
Name:NIEKAMP, REBECCA LEE (RD, LD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEE
Last Name:NIEKAMP
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9468
Mailing Address - Country:US
Mailing Address - Phone:419-739-9736
Mailing Address - Fax:
Practice Address - Street 1:1100 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9468
Practice Address - Country:US
Practice Address - Phone:419-739-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered