Provider Demographics
NPI:1003281544
Name:RARY, REBEKAH (MT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:RARY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 E FOLGADO CT
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5181
Mailing Address - Country:US
Mailing Address - Phone:208-320-8438
Mailing Address - Fax:
Practice Address - Street 1:922 E FOLGADO CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5181
Practice Address - Country:US
Practice Address - Phone:208-320-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-1552172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker