Provider Demographics
NPI:1043503881
Name:EBERLY, REBECCA D (RDN/CDE)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:EBERLY
Suffix:
Gender:F
Credentials:RDN/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-1728
Mailing Address - Country:US
Mailing Address - Phone:720-447-1650
Mailing Address - Fax:
Practice Address - Street 1:144 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1728
Practice Address - Country:US
Practice Address - Phone:720-447-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
971129133V00000X
NV971129133VN1006X
NV33357D1-0133VN1006X
NV21220137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic