Provider Demographics
NPI:1750687547
Name:CUSHING, REBECCA E (RD CD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:CUSHING
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:E
Other - Last Name:CUSHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD CD
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8150
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:SUITE 122
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-429-0610
Practice Address - Fax:801-429-0629
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103367-4901174H00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00373731OtherAMERICAN DIETETIC ASSOCIATION
UT103367-4901OtherUTAH STATE LICENSE