Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 074841 | IA |
NPI | 1609275163 |
---|---|
Provider Name | Jahnaya Marcia Rebarcak |
First Address | Ames, IA 50010-4093 |
Second Address | Ames, IA 50010-4093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |