Provider Demographics
NPI:1174287635
Name:HEANSSLER, REBECCA KATHERINE (RD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KATHERINE
Last Name:HEANSSLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KATHERINE
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:55 NEW ROCHESTER RD APT 2
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2161
Mailing Address - Country:US
Mailing Address - Phone:774-633-0730
Mailing Address - Fax:
Practice Address - Street 1:55 NEW ROCHESTER RD APT 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2161
Practice Address - Country:US
Practice Address - Phone:774-633-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty