Provider Demographics
NPI:1497536205
Name:HUMES, REBECCA EILEEN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EILEEN
Last Name:HUMES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IN
Mailing Address - Zip Code:47944-0052
Mailing Address - Country:US
Mailing Address - Phone:574-850-0143
Mailing Address - Fax:
Practice Address - Street 1:2109 E 100 N
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:IN
Practice Address - Zip Code:47944-8508
Practice Address - Country:US
Practice Address - Phone:765-715-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167318A163WM0102X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn