Provider Demographics
NPI:1063842318
Name:REBECK, MARCENE ELLEN (DIRECT ENTRY MIDWIFE)
Entity Type:Individual
Prefix:
First Name:MARCENE
Middle Name:ELLEN
Last Name:REBECK
Suffix:
Gender:F
Credentials:DIRECT ENTRY MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:88884 BROWN LANE
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-0317
Mailing Address - Country:US
Mailing Address - Phone:541-347-9175
Mailing Address - Fax:
Practice Address - Street 1:88884 BROWN LN
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8305
Practice Address - Country:US
Practice Address - Phone:541-347-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife