Provider Demographics
NPI:1053653915
Name:OVERSTREET, REBEKAH MILLER (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:MILLER
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:HARPER
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:21169 BOSTON TER
Mailing Address - Street 2:APT. 312
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6687
Mailing Address - Country:US
Mailing Address - Phone:703-966-9356
Mailing Address - Fax:
Practice Address - Street 1:21169 BOSTON TER
Practice Address - Street 2:APT. 312
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6687
Practice Address - Country:US
Practice Address - Phone:703-966-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1044879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered