Provider Demographics
NPI:1376788695
Name:MENGE, REBECCA ANNE (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:MENGE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 VERDITE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3075
Mailing Address - Country:US
Mailing Address - Phone:970-210-2480
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS ROAD
Practice Address - Street 2:#120
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered