1134344864 NPI number — MS. REBECCA C. METCALF CFNP

Table of content: MS. REBECCA C. METCALF CFNP (NPI 1134344864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134344864 NPI number — MS. REBECCA C. METCALF CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METCALF
Provider First Name:
REBECCA
Provider Middle Name:
C.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134344864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 WIGGIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAMBIER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43022-9649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-427-2414
Provider Business Mailing Address Fax Number:
740-427-2415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 MARKET ST
Provider Second Line Business Practice Location Address:
THE SANCTUARY
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43014-9649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-599-7224
Provider Business Practice Location Address Fax Number:
740-599-7244
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN.149467-COA1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2034202 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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