Provider Demographics
NPI:1740315001
Name:WARDRIP, REBECCA LOUISE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:WARDRIP
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 1:5118 SANTOY RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:OH
Mailing Address - Zip Code:43730
Mailing Address - Country:US
Mailing Address - Phone:740-605-2667
Mailing Address - Fax:
Practice Address - Street 1:4610 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764
Practice Address - Country:US
Practice Address - Phone:740-753-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2297732Medicaid