Provider Demographics
NPI:1700883907
Name:HONAKER, REBECCA A (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HONAKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5381
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5381
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58257163W00000X
OH10222367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000204520OtherOH MEDICAID UNISON
000000510971OtherANTHEM BCBS
WV3810004491Medicaid
OH2213741Medicaid
P00378048OtherRR MEDICARE
001714055OtherMOUNTAIN STATE BCBS
OH2213741OtherOH MEDICAID MOLINA
OH310917085174OtherOH MEDICAID CARESOURCE
001714055OtherMOUNTAIN STATE BCBS