Provider Demographics
NPI:1386859924
Name:RATHBURN, NANCY O'NEIL (MS)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:O'NEIL
Last Name:RATHBURN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 JEBB ISLAND CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7923
Mailing Address - Country:US
Mailing Address - Phone:904-821-8878
Mailing Address - Fax:
Practice Address - Street 1:4012 JEBB ISLAND CIR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7923
Practice Address - Country:US
Practice Address - Phone:904-821-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health