Provider Demographics
NPI:1326194770
Name:GRAEVE, REBECCA J (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:GRAEVE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 N. COURT
Mailing Address - Street 2:HY-VEE #1505
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-683-3341
Mailing Address - Fax:641-683-5949
Practice Address - Street 1:2453 N. COURT
Practice Address - Street 2:HY-VEE #1505
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-683-3341
Practice Address - Fax:641-683-3341
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered