Provider Demographics
NPI:1245428747
Name:DEAN, REBECCA ANN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 29TH AVE
Mailing Address - Street 2:164 29TH AVE
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-7462
Mailing Address - Country:US
Mailing Address - Phone:707-208-3379
Mailing Address - Fax:620-327-5174
Practice Address - Street 1:164 29TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-7462
Practice Address - Country:US
Practice Address - Phone:707-208-3379
Practice Address - Fax:620-327-5174
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM220176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife