Provider Demographics
NPI:1952531261
Name:FORD, REBECCA DIANE (NMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DIANE
Last Name:FORD
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14700 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:#157-331
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2046
Mailing Address - Country:US
Mailing Address - Phone:480-495-5284
Mailing Address - Fax:830-336-4512
Practice Address - Street 1:14700 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:#157-331
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2046
Practice Address - Country:US
Practice Address - Phone:480-495-5284
Practice Address - Fax:830-336-4512
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1119175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath