Provider Demographics
NPI:1205633393
Name:CARMICKLE, REBEKAH MARIE
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARIE
Last Name:CARMICKLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N A ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3464
Mailing Address - Country:US
Mailing Address - Phone:765-914-1498
Mailing Address - Fax:
Practice Address - Street 1:1905 N A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3464
Practice Address - Country:US
Practice Address - Phone:765-914-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician