Individual
REBECCA A BASSHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, RT
Contact information
Practice address
2277 SWANSON AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5991
(928) 486-5414
(928) 854-0112
Mailing address
2277 SWANSON AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5991
(928) 486-5414
(928) 854-0112
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
174H00000X
Health Educator
—
—
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
06/20/2013
Last updated
06/20/2013
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