Provider Demographics
NPI:1225633639
Name:SCULL, REBECCA M (CNM)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:SCULL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34576 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4593
Mailing Address - Country:US
Mailing Address - Phone:909-659-4651
Mailing Address - Fax:
Practice Address - Street 1:34576 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4593
Practice Address - Country:US
Practice Address - Phone:909-659-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife