Provider Demographics
NPI:1487206868
Name:MAURILLO, REBECCA (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MAURILLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2203 STURNELLA LN
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7721
Mailing Address - Country:US
Mailing Address - Phone:512-656-7293
Mailing Address - Fax:
Practice Address - Street 1:2002 N 22ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3153
Practice Address - Country:US
Practice Address - Phone:406-282-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT997839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered