Provider Demographics
NPI:1407318108
Name:MUTAI, REBBY CHEPKORIR
Entity Type:Individual
Prefix:
First Name:REBBY
Middle Name:CHEPKORIR
Last Name:MUTAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 ROSWELL CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4800
Mailing Address - Country:US
Mailing Address - Phone:704-258-5307
Mailing Address - Fax:
Practice Address - Street 1:7902 ROSWELL CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4800
Practice Address - Country:US
Practice Address - Phone:704-258-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse