Provider Demographics
NPI:1932726783
Name:CASTLE, REBECCA MOORE (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MOORE
Last Name:CASTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-1733
Mailing Address - Country:US
Mailing Address - Phone:507-673-3197
Mailing Address - Fax:
Practice Address - Street 1:327 SUNSET RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-7680
Practice Address - Country:US
Practice Address - Phone:570-772-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN278498L163W00000X
PASP023605207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No163W00000XNursing Service ProvidersRegistered Nurse