Basic Information
Provider Information | |||||||||
NPI: | 1912173709 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIMPSON | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | HOUSEAL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., R.D., L.D.N. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOUSEAL | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S., R.D., L.D.N. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 603949 | ||||||||
Address2: |   | ||||||||
City: | CHARLOTTE | ||||||||
State: | NC | ||||||||
PostalCode: | 282603949 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193508991 | ||||||||
FaxNumber: | 9193507687 | ||||||||
Practice Location | |||||||||
Address1: | 23 SUNNYBROOK RD | ||||||||
Address2: |   | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276101855 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9192356439 | ||||||||
FaxNumber: | 9192310314 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2008 | ||||||||
LastUpdateDate: | 11/01/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/01/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L003189 | NC | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.