Provider Demographics
NPI:1891192571
Name:BLYTHE, REBEKAH (CPM)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 COUNTY ROAD 515
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-8709
Mailing Address - Country:US
Mailing Address - Phone:970-749-4497
Mailing Address - Fax:
Practice Address - Street 1:679 E 2ND AVE STE 4/5
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5563
Practice Address - Country:US
Practice Address - Phone:970-749-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COM.W.R.0000159176B00000X
NM14130R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife