Provider Demographics
NPI:1013150861
Name:RABENA, REBECCA (RD)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:RABENA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD STE 111
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4504
Mailing Address - Country:US
Mailing Address - Phone:856-861-6320
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD STE 111
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4504
Practice Address - Country:US
Practice Address - Phone:856-861-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered