Provider Demographics
NPI:1043467111
Name:SNOW, REBECCA JOHNSON (LN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JOHNSON
Last Name:SNOW
Suffix:
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LN
Mailing Address - Street 1:145 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5140
Mailing Address - Country:US
Mailing Address - Phone:443-315-5221
Mailing Address - Fax:
Practice Address - Street 1:145 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5140
Practice Address - Country:US
Practice Address - Phone:443-315-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2581133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist