Provider Demographics
NPI:1134631096
Name:ROLAND, REBECCA A (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ROLAND
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295 GERMANTOWN BEND CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7238
Mailing Address - Country:US
Mailing Address - Phone:901-759-9337
Mailing Address - Fax:901-759-7967
Practice Address - Street 1:295 GERMANTOWN BEND CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7238
Practice Address - Country:US
Practice Address - Phone:901-759-9337
Practice Address - Fax:901-759-7967
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered