Provider Demographics
NPI:1588803522
Name:BEAUDOIN, REBECCA KAI (RD LMNT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KAI
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:RD LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2565
Mailing Address - Country:US
Mailing Address - Phone:402-731-6107
Mailing Address - Fax:
Practice Address - Street 1:3505 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2565
Practice Address - Country:US
Practice Address - Phone:402-731-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE914133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered