MEDICARE: MRS. REBECCA DAWN GIBBONS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689967572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA DAWN GIBBONS

Provider Business Mailing Address
First Line	:	1567 N MAIN ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-2978
Country	:	US
Telephone Number	:	508-324-1060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1567 N MAIN ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-2978
Country	:	US
Telephone Number	:	508-324-1060
Fax Number	:

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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