Provider Demographics
NPI:1699106195
Name:HALL, REBECCA LYNN (RD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 758997
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275
Mailing Address - Country:US
Mailing Address - Phone:804-281-0626
Mailing Address - Fax:804-662-7302
Practice Address - Street 1:1250 EAST MARSHALL ST
Practice Address - Street 2:CLINICAL NUTRITION SERVICES
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0509
Practice Address - Country:US
Practice Address - Phone:804-828-5765
Practice Address - Fax:804-628-0921
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered