Provider Demographics
NPI:1770083297
Name:REAM, REBECCA SUE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:REAM
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 1:11900 E 150 S
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9579
Mailing Address - Country:US
Mailing Address - Phone:574-842-2193
Mailing Address - Fax:574-842-2193
Practice Address - Street 1:11900 E 150 S
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-9579
Practice Address - Country:US
Practice Address - Phone:574-842-2193
Practice Address - Fax:574-842-2193
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0701003376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide