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NPI Code Detail

MEDICARE: REBECCA FAGEN HOUGHTON

MEDICARE: REBECCA FAGEN HOUGHTON
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1780375121
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA FAGEN HOUGHTON
Provider Business Mailing Address
First Line : 5010 N STONE MILL RD STE B
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47408-9320
Country : US
Telephone Number : 812-929-2193
Fax Number :
Provider Business Practice Location Address
First Line : 501 S MADISON ST STE 105
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2452
Country : US
Telephone Number : 812-929-2193
Fax Number : 888-789-8394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2023
Last Update Date : 05/17/2023

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Directions to “ REBECCA FAGEN HOUGHTON ” Practice Location

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