Provider Demographics
NPI:1619444577
Name:BOOVA-TURNER, REBECCA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOOVA-TURNER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E FLETCHER STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125
Mailing Address - Country:US
Mailing Address - Phone:302-588-1069
Mailing Address - Fax:
Practice Address - Street 1:1234 E FLETCHER STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:302-588-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86048588133V00000X
PADN006067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered