Provider Demographics
NPI:1275818379
Name:MARTIN, REBECCA R (RN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
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Other - Last Name:
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Mailing Address - Street 1:2831 NEW HARTFORD RD
Mailing Address - Street 2:RIDGECREST MEDICAL PARK
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-926-4100
Mailing Address - Fax:270-684-4678
Practice Address - Street 1:2831 NEW HARTFORD RD
Practice Address - Street 2:RIDGECREST MEDICAL PARK
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-926-4100
Practice Address - Fax:270-684-4678
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1074301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse