Provider Demographics
NPI:1487675864
Name:MUNGER, REBECCA LOUISE (CNM)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LOUISE
Last Name:MUNGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LOUISE
Other - Last Name:MUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:15620 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-9617
Mailing Address - Country:US
Mailing Address - Phone:707-473-4531
Mailing Address - Fax:707-473-4559
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-571-1280
Practice Address - Fax:707-578-5849
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife