Provider Demographics
NPI:1154323319
Name:MOONEY, REBECCA S (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:MOONEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2479
Mailing Address - Country:US
Mailing Address - Phone:410-272-3233
Mailing Address - Fax:410-273-9465
Practice Address - Street 1:19 WALNUT LN
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2479
Practice Address - Country:US
Practice Address - Phone:410-272-3233
Practice Address - Fax:410-273-9465
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS63785Medicare UPIN