MEDICARE: REBA DAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0035495	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023867249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBA DAS

Provider Business Mailing Address
First Line	:	4235 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4299
Country	:	US
Telephone Number	:	419-473-3561
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 WOODLEY RD STE C
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1177
Country	:	US
Telephone Number	:	419-841-1600
Fax Number	:	419-841-4181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	12/05/2025

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Directions to “ REBA DAS ” Practice Location

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