Provider Demographics
NPI:1790037901
Name:WAMPLER, REBECCA SUE
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:WAMPLER
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 1:305 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOURBON
Mailing Address - State:IN
Mailing Address - Zip Code:46504-1614
Mailing Address - Country:US
Mailing Address - Phone:574-342-0431
Mailing Address - Fax:
Practice Address - Street 1:305 E. NORTH ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1416
Practice Address - Country:US
Practice Address - Phone:574-342-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care