Provider Demographics
NPI:1578440061
Name:EDWIN, REBECCAH (RD)
Entity type:Individual
Prefix:
First Name:REBECCAH
Middle Name:
Last Name:EDWIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E JAMES ST
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1517
Mailing Address - Country:US
Mailing Address - Phone:650-698-7622
Mailing Address - Fax:
Practice Address - Street 1:413 E JAMES ST
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-1517
Practice Address - Country:US
Practice Address - Phone:650-698-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86064627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered