Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2013007345 | MO |
NPI | 1609119148 |
---|---|
Provider Name | Dr. Rebecca Rose Furlano |
First Address | Saint Louis, MO 63105-2640 |
Second Address | Troy, MO 63379-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2013 |
Last Update Date | 14/01/2019 |