Provider Demographics
NPI:1184206898
Name:MABIE, REBECCA (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MABIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 E 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4338
Mailing Address - Country:US
Mailing Address - Phone:307-577-5100
Mailing Address - Fax:
Practice Address - Street 1:6500 E 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4339
Practice Address - Country:US
Practice Address - Phone:307-577-5100
Practice Address - Fax:307-233-0596
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17326A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine