Provider Demographics
NPI:1255159992
Name:LONG, REBECCA L (RDN, LDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2043
Mailing Address - Country:US
Mailing Address - Phone:513-594-1004
Mailing Address - Fax:
Practice Address - Street 1:9800A MCKNIGHT RD STE 205
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6006
Practice Address - Country:US
Practice Address - Phone:412-593-2048
Practice Address - Fax:844-311-7396
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN003827OtherPA RDN LICENSE