Provider Demographics
NPI:1871206086
Name:GILLIGAN, REBECCA MEGAN (RDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MEGAN
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MEGAN
Other - Last Name:PRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4430 E COYOTE WASH DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4024
Mailing Address - Country:US
Mailing Address - Phone:480-390-5352
Mailing Address - Fax:
Practice Address - Street 1:4430 E COYOTE WASH DR
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4024
Practice Address - Country:US
Practice Address - Phone:480-390-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1018278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered