Provider Demographics
NPI:1356899538
Name:LOONEY, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOONEY
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 1:5144 E STOP 11 RD
Mailing Address - Street 2:STE 18
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8674
Mailing Address - Country:US
Mailing Address - Phone:317-426-0678
Mailing Address - Fax:317-316-3372
Practice Address - Street 1:5144 E STOP 11 RD
Practice Address - Street 2:STE 18
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8674
Practice Address - Country:US
Practice Address - Phone:317-426-0678
Practice Address - Fax:317-316-3372
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1245532085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound