Provider Demographics
NPI:1104017425
Name:HERMSEN, REBECKA MARSH (RD, CD)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:MARSH
Last Name:HERMSEN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALLA WALLA COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:310 W. POPLAR
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0346
Mailing Address - Country:US
Mailing Address - Phone:509-524-2670
Mailing Address - Fax:509-524-2681
Practice Address - Street 1:WALLA WALLA COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:310 W. POPLAR
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-0346
Practice Address - Country:US
Practice Address - Phone:509-524-2670
Practice Address - Fax:509-524-2681
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8275653Medicaid