Provider Demographics
NPI:1669616231
Name:KOLLER, REBECCA ANN (CPM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:KOLLER
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 1:164A HENRY LN
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04353-3318
Mailing Address - Country:US
Mailing Address - Phone:207-841-1771
Mailing Address - Fax:
Practice Address - Street 1:164A HENRY LN
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:ME
Practice Address - Zip Code:04353-3318
Practice Address - Country:US
Practice Address - Phone:207-841-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6039257176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife