Provider Demographics
NPI:1528947884
Name:HANBERG, REBECCA (MS, RDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HANBERG
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 S 2100 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-1456
Mailing Address - Country:US
Mailing Address - Phone:307-679-0503
Mailing Address - Fax:
Practice Address - Street 1:2909 WASHINGTON BLVD STE 209
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4054
Practice Address - Country:US
Practice Address - Phone:801-796-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12923567-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered