Provider Demographics
NPI:1275772535
Name:EGBERT, REBECCA SNELL (CPM, LM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SNELL
Last Name:EGBERT
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2507
Mailing Address - Country:US
Mailing Address - Phone:406-586-6393
Mailing Address - Fax:
Practice Address - Street 1:362A CHASE WAY
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5404
Practice Address - Country:US
Practice Address - Phone:406-586-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife