Provider Demographics
NPI:1255582482
Name:HAIR, REBECCA PRUDHOMME (RD, LDN, BS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:PRUDHOMME
Last Name:HAIR
Suffix:
Gender:F
Credentials:RD, LDN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6548
Mailing Address - Fax:985-230-6563
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:FINANCE DEPARTMENT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6548
Practice Address - Fax:985-230-6563
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2054133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered