Provider Demographics
NPI:1336782176
Name:SHIRRELL, REBEKAH ELIZABETH RICH (CNM)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELIZABETH RICH
Last Name:SHIRRELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GORDON GUTMANN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3766
Mailing Address - Country:US
Mailing Address - Phone:812-282-6114
Mailing Address - Fax:812-650-5315
Practice Address - Street 1:301 GORDON GUTMANN BLVD # 210
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3764
Practice Address - Country:US
Practice Address - Phone:812-282-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009521A367A00000X
IN09000334A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71009521AOtherIN LICENSE