Provider Demographics
NPI:1689003469
Name:HURST DAVIS, REBECCA (MS,RD,CSP,CD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HURST DAVIS
Suffix:
Gender:F
Credentials:MS,RD,CSP,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:SOM 3R149
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0100
Mailing Address - Country:US
Mailing Address - Phone:801-585-9717
Mailing Address - Fax:801-587-9346
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:SOM 3R149
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0100
Practice Address - Country:US
Practice Address - Phone:801-585-9717
Practice Address - Fax:801-587-9346
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353807-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered